“Fulfilling Our Promise: Eradicate Polio”

Polio Eradication Fundraising Campaign 2002-2003

Rotary Club Commitment Form

Our Rotary Club is pleased to report that we will support the Polio Eradication Fundraising Campaign (PEFC), and has established a commitment of US$___________, to be raised in cash donations and pledges during the Rotary year 2002-2003.  Our Rotary club will seek the support of others in our community for the global polio eradication effort. 

We understand that all contributions to the Campaign will be used for the needs of the global polio eradication program—vaccine, immunization operations, and the costs of improving and maintaining the laboratories and surveillance systems necessary to achieve a polio-free world by the time of Rotary’s 100^th anniversary in 2005. 

In developing our Campaign goal, our club considered the following sources of financial support (indicate amounts in appropriate categories):

 Source                                               Amount

 Members joining since 1988               ______________

Other Club members                            ______________

Major Donors (US$10,000+)               ______________

Community fundraising events             ______________

Interact Club fundraisers                       ______________

Rotaract Club fundraisers                     ______________

Business/Corporate donations            ______________

Other (club fund, etc.)                            ______________

Total Rotary Club Commitment      ______________

Name of Rotary Club__________________________________________________ 

Rotary District_______________________________________________________ 

Signature of Club President _____________________________________________ 

Name of Club President (please type or print)________________________________ 

Please duplicate and provide a copy to your District Area Coordinator.

Polio Eradication Fundraising Campaign

The Rotary Foundation

1560 Sherman Avenue

Evanston, IL 60201 USA

Fax: 847 328 4101