If you have any questions regarding the PolioPlus Society, please reach out to Jim Lewis, District PolioPlus Subcommittee Chair jameslewis1118@gmail.com

As a Rotarian and supporter of Polio Eradication, Rotary's Number One Priority, I wish to participate in the Countdown to History as a member of the PolioPlus Society of Rotary District 5240

Joining the PolioPlus Society is a two-step process.

First: complete this form and a copy will be emailed to District PolioPlus Subcommittee Chair Jim Lewis.
I hereby commit to making an annual donation to the PolioPlus Fund of The Rotary Foundation as follows (select one): 
I pledge to help Rotary make history by continuing to contribute the above amount each year until the World Health Organization certifies that polio has been fully eradicated.

Until the world is polio-free, every child is at risk.
You will receive a PolioPlus Society certificate, PolioPlus Pin, and an End Polio Now Bracelet, which will be presented at a club meeting to make sure you are recognized for your commitment to polio eradication.
Second: Make your donation in one of the ways described below.

To make your tax-deductible donation, go to my.rotary.org/donate and click on "Polio Fund".

You can choose a one-time donation of $100 or more, or a recurring donation in the amount and frequency of your choice. (We suggest $10/month as the "easy way" to become a PolioPlus Society member.)

Of course, you can also write a check payable to "The Rotary Foundation", with PolioPlus in the memo section, and give it to your club's Foundation Chair.

Your contribution also qualifies for Paul Harris Recognition Points and will be matched 2 to 1 by the Bill & Melinda Gates Foundation.

Email a copy of your confirmation to polioplussociety@rotary5240.com
Date: Saturday, 18 May 2024 (EDT)
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Scan this QR code with your phone:
Scan QR code to sign