Rotary Challenge Coin Form (For Members Only)
To celebrate the 100th anniversary of The Rotary Foundation, District 5170 is currently offering beautiful challenge coins for donations to TRF during the 2016-2017 Rotary Year (which is from July 1, 2016 to June 30, 2017)! These coins have the 100th anniversary logo on one side and the 4-Way Test on the other.

Members who donate the following amounts will receive the following coins:

$1000 - Gold
$500 - Silver
$200 - Bronze

Simply fill out the form below and receive one of these really cool coins!

Your Name *
Your answer
Donation level to TRF in 2016 - 2017 *
Please write the mailing address to send the coin(s) *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms