Polio Plus Society Pledge Form

Be A Part of History

The PolioPlus Society is an organization of like-minded individuals who have committed to contribute $100 or more each and every year to Polio Plus until the world has been declared free of the Wild Polio Virus. This is our commitment to fulfil the promise Rotary made in 1985 to immunize all the children of the world. It’s easy and rewarding to become a member.

As a supporter of Polio Eradication, Rotary’s Number One Priority, I wish to participate in the Countdown to History as a member of the Polio Plus Society of District 9142.

I pledge to help Rotary make history by contributing $100 or more each and every year until the World Health Organization certifies that the Wild Polio Virus has been fully eradicated from the world.

This is my commitment to fulfill the promise Rotary made to immunize all the children of the world.

Society members will receive a PolioPlus Society membership pin, certificate and an End Polio Now bracelet… and your contribution qualifies for Paul Harris Recognition Points credit.

I hereby commit to making an annual donation to the PolioPlus Fund of The Rotary Foundation as follows (select one): *

($100 - minimum amount to become a POLIOPLUS SOCIETY MEMBER)

Rotary ID Number *

Club Name *

Email Address *

Mobile Number *

Full Name *

First

Last

Submit the form and complete your contribution commitment in one of two ways:

1. Contribute with your credit card online at: https://www.endpolio.org/donate.

-Or-

2. Make out a check for $100 or more to The Rotary Foundation, with “Polio Plus” in the Memo section and submit to your Rotary Clubs Foundation Chair.

All donations will be matched 2 to 1 by the Bill and Melinda Gates Foundation.

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