To Pay by Credit Card, Go to Is an Extra Convenience Charge of 3% + $0.30 for Paying With

PO Box 964 Elkhorn, NE 68022 / CHARITABLE STATEMENT
JULY 1, 2016 THROUGH JUNE 30, 2017
Please go to the website to check that your information is correct online:
select the “Member Area” button in the top right corner
If you do not remember your user name and password, Select the “retrieve login” text line
Name ______
Address ______
Preferred Address: Home or Business
SERVICE FUND – Club Committee Projects
MANDATORY MINIMUM DONATION / Your Donation / Additional
Donation
2016-2017 Service Fund(minimum contribution)
2017-2018 Service Fund(minimum contribution)
The Service Funds Club Committee Projects. By collecting the 2017-2018 contributions in advance, the total budget is known for committee grant requests. Therefore, your statement next year will not include a service fund contribution. PLEASE consider a higher amount if you can. / $100
$100 /
$______
Matching Funds from your Company? ☒
$______
Minimum amount due at this time: / $200
ADDITIONAL VOLUNTARY DONATIONS / Your Donation / Additional
Donation
Rotary Honor Roll Sponsorships
Our Rotary Honor Roll program needs additional funding from you and/or your company to continue each year. See additional documents on sponsorship levels for the luncheon. /
$_____ /
$______
The Rotary Foundation – Local & International Projects
2016-2017 Annual Fund (EREY)
Crucial to sustain the thousands of projects that are being conducted in your community and around the world. Every Rotarian, Every Year (EREY) is the fundraising vehicle for the Annual Fund. /
$_____ / $______
2016-2017 Polio Plus Fund
Be a part of history and support Rotary's work to achieve a polio-free world by supporting immunization campaigns in countries where children remain at risk /
$_____ / $______
*Note, when $1,000 is donated to The Rotary Foundation through any combination of donations to the Annual Fund or Polio Plus, the donor is recognized as a Paul Harris Fellow.
TOTAL Enclosed
If you are interested in making a bequest to our Club's Foundation to further community grants for Seniors, Veterans, and Education, please check the box and a Foundation board member will be in touch with you. / ☒

To pay by credit card, go to is an extra convenience charge of 3% + $0.30 for paying with credit card.

According to the IRS, Dues are not tax deductible as a charitable expense. However, contributions to the Service Fund, Downtown Rotary Foundation and Rotary International may be tax-deductible. As always, consult your tax advisor regarding this issue.