Rotary Club of Beaver Purchaser InformationName* First Last Email* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Flag InformationHow Many Flags Are You Sponsoring? Quantity*You can only list one hero per flag Price: $50.00 Quantity Sponsor and Hero Information*If sponsoring more than one flag, please use the plus sign on the right end of each line below to add a new line. This will allow you to choose the names for the additional flags that you are sponsoring.Sponsor Name(s)Hero NameVeteran? Yes or No * I understand that my donation will not result in me receiving a physical product. Total $0.00 Payment InformationHow would you like to pay?* Mail Check Credit Card Credit CardCard Details Cardholder Name Makes checks payable to: The Rotary Club of Beaver Write in Memo Line"Beaver Community Heroes Fund" Mail to: PO Box 513 Beaver, PA 15009 Checks must be received by Beaver Rotary no later than Wednesday June 24th, 2024 Upon completion of this form, you will see a link to print a PDF version of this order. Please print that and mail with your payment so we can ensure your payment is credited properly.
