n n n n 102EN1511013 1 RECIPIENT OF RECOGNITION Transfer Recognition Points toName Recipient ID Number Club Name Address City StateProvince Country ostal Code Daytime Phone ID: 411457
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n n n n 102-EN—(1013) PAUL HARRIS FELLOW RECOGNITION TRANSFER REQUEST FORMPlease send your completed form only once. If you have questions regarding recognition or contributions to The Rotary Foundation, please contact Rotary’s Support Center at 1-866-9ROTARY (1-866-976-8279), or email: contact.center@rotary.org or, contact the Rotary International of ce that serves your area.www.rotary.org/give 1. RECIPIENT OF RECOGNITION Transfer Recognition Points to:Name: Recipient ID Number: Club Name: Address: City: State/Province: Country: ostal Code: Daytime Phone: Email Address: 2. TRANSFER RECOGNITION POINTS Foundation Recognition Points Amount: Transferring Recognition Points from: Individual ID Number: Club Number: District Number: AUTHORIZED SIGNATURE (required): Print Name: 3. SHIPPING INFORMATION — Presentation Date: Send recognition to: (Check one; if left blank, recognition will be sent to club president) Club President Club Secretary Club Treasurer Club Foundation Chair Other, record information belowName: Address: City, State/Prov.: , Postal Code: Daytime Phone: Email Address: 4. AL COMPLETING THIS FORM Name: Daytime Phone: Email Address: Date: Please send this form to the appropriate address.UNITED STATESThe Rotary FoundationChicago, IL 60693 USA Tel: 1-866-976-8279 (toll-free)Fax: +1-847-328-4101contact.center@rotary.orgCANADAThe Rotary Foundation (Canada) P.O. Box 4090 STN AToronto, ON M5W 0E9 Tel: 1-866-976-8279 (toll-free)Fax: +1-847-328-4101contact.center@rotary.orgGemeindienst e. V.Rua Tagipuru 209São Paulo, SPTel: (55-11) 3826-2966 Paul Harris Fellow Recognition Transfer Request Form, Page 1