Rotary - Flag Subscription Form

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If subscribing, please provide the following information:

Email *

First/Last Name: *

Phone: *

Number of flags ordered: (subscription price for initial flag for initial two years for one flag is $75, for one year $50 ) If you choose to have an additional flag(s), the subscription price is $60 for two years and $40 for one year for an additional flag at the same location. *

One flag, for one year from subscription. - You will be billed for $50.

One flag for two years. You will be billed for $75 for both years.

Two flags for one year, you will be billed for $90.00

Two flags for two years. You will be billed $130 for both years.

More than two flags, describe your needs below at the end of this form in "special instructions.".

Billing Address, assuming Kirksville MO 63501: *

Flag site, if different from billing address:

Your name, if courtesy submission by a Rotarian:

Someone will call Missouri One to have your utiliites marked. This will occur a few weeks before the hidden base is installed. Thank you for your support. Add any special instructions below.

Upon conclusion of submitting this information, you will be asked to submit payment.

A copy of your responses will be emailed to the address you provided.

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