*Sponsor/Corporation Name: (As printed on Media)

*Contact Name:
URL:
*Address:
*City: State: Zip:
*Phone: Enter phone and fax in this style: 222-222-2222
Fax:
*Email:

Secondary Contact Name:
Address:
City: State: Zip:
Phone: Enter phone and fax like: 222-222-2222
Fax:
Email:

Level of Sponsorship:

Special Message/Instruction:

We are unable to sponsor this year, but please accept this cash donation in the amount of: $

We are unable to sponsor this year, but would like a Rotarian to contact us in regards to an auction item.

NOTE: This site is not set up to receive payment information, do not enter any payment or credit card information in this form. A Rotary member will contact you shortly to arrange payment for sponsorship.