POLIO PLUS SOCIETY

MEMBERSHIP FORM
As a Rotarian and supporter of Polio Eradication, Rotary's #1 priority, I wish to
participate in this humanitarian endeavor as a member of the PolioPlus Society of
Rotary International District 3860
Therefore, I hereby commit myself to contribute to the Polio Plus Fund annually
with a minimum of $100 to become a Polio Plus Society member and to support
the PolioPlus Program of the Rotary International.
Society members will receive a PolioPlus Society membership pin, Membership
certificate and Paul Harris credit.
Coordinate to your Club or District Polio Plus Society Coordinator on how to
Donate.
Email to: _____________________________

NAME: ________________________________________

SIGNATURE : __________________________________

DATE : October 12, 2023

CLUB NAME : Rotary Club of Metro Koronadal

DONOR ID NO. ________________________________

EMAIL ADDRESS :
______________________________

CONTACT NO : ________________________________

PolioPlus Society membership

materials will be mailed to
your club president for
presentation at a club meeting.
We want you to be properly
recognize for you commitment
to polio eradication.