Rotary Club of Beaver, PA - Flags for Heroes Program - Memorial Day 2019 Purchaser InformationName* First Last Email* PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Flag InformationHow Many Flags Are You Sponsoring?*You can only list one hero per flag Price: $50.00 Quantity: Sponsor and Hero Information*Use the plus sign on the right to add more lines for 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 CheckCredit CardCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Makes checks payable to: The Rotary District 7300 Foundation 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 Friday, May 9, 2018 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.
