The Paul Harris Society of District 5810 Membership Form

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1 The Paul Harris Society of District 5810 Membership Form THE PAUL HARRIS SOCIETY Each donor who contributes $1,000 or more to The Rotary Foundation s Annual Programs Fund will be awarded membership into the Paul Harris Society. As the popularity of our Foundation s humanitarian, educational & cultural programs increase and we celebrate our successes, it is important to recognize that those outcomes are not sustainable unless we annually contribute the income needed. X I wish to become a Member of the Paul Harris Society X I promise to contribute $1,000 annually to The Rotary Foundation. X I wish my donation to be designated to the Rotary Foundation s Annual Programs Fund unless directed otherwise. Please send this form to: Courtenay Tanner, PHS Chair, 401 Ridgehaven Place, Richardson, Payment Preferred: I am enclosing a check I am enclosing a credit card contribution form X I am enclosing a TRF-DIRECT form Name: Bill Perryman Address: Merit Drive, Ste Dallas, TX Phone: Club: East Dallas

2 The Paul Harris Society of District 5810 Membership Form THE PAUL HARRIS SOCIETY Each donor who contributes $1,000 or more to The Rotary Foundation s Annual Programs Fund will be awarded membership into the Paul Harris Society. As the popularity of our Foundation s humanitarian, educational & cultural programs increase and we celebrate our successes, it is important to recognize that those outcomes are not sustainable unless we annually contribute the income needed. I wish to become a Member of the Paul Harris Society I promise to contribute $1,000 annually to The Rotary Foundation. I wish my donation to be designated to the Rotary Foundation s Annual Programs Fund unless directed otherwise. Please send this form to: Courtenay Tanner, PHS Chair, 401 Ridgehaven Place, Richardson, Payment Preferred: I am enclosing a check I am enclosing a credit card contribution form I am enclosing a TRF-DIRECT form Name: Address: Phone: Club:

3 TRF-DIRECT Credit Card Authorization Connect Name Address City State Postal Code Phone Rotary Club # District # Rotary Membership ID # q Non-Rotarian Credit Rotary Club of Credit Card Information Please charge my: (mark one below) q Visa q MasterCard q American Express 3-digit security code Account # Expiration The Every Rotarian, Every Year effort is aimed at encouraging Rotarians worldwide to participate fully in the mission of Rotary through their ideal of service and their generosity to support the programs and works of Rotary around the world! TRF DIRECT DONATIONS I hereby authorize The Rotary Foundation to charge US$ (minimum US$25 per transaction) on (choose one below) q 1st of every month q 15th of every month q 1st of every quarter q Annually (specify month: ) THANK YOU FOR YOUR SUPPORT! from the credit card indicated above. I understand that each transaction will appear on my regular credit card statement. I further understand that it is my responsibility to notify The Rotary Foundation if there are any changes to my credit card account that will affect my TRF-DIRECT participation. This authority remains in effect until I notify The Rotary Foundation in writing and the Foundation has had a reasonable amount of time to fulfill my request. The Rotary Foundation can terminate this agreement at any time. The Rotary Foundation of Rotary International TRF-DIRECT, FD420 One Rotary Center 1560 Sherman Avenue Evanston, IL USA Phone: Fax: EN-USA (108) Direct

4 Connect... Support the educational and humanitarian programs of The Rotary Foundation! Become a Rotary Foundation Sustaining Member! ($100 annually) $10 per month helps provide tuition and books for one year of school for two children in Sri Lanka $25 quarterly helps provide cataract operations for three blind individuals in India Become a Paul Harris Society Member! ($1,000 annually) $100 per month helps provide materials to construct a deep borewell in Kenya, supplying clean water to more than 300 people $250 quarterly helps provide parasite and anemia prevention materials for needy children in Uruguaiana, RS, Brazil CONVENIENT Direct... TRF-DIRECT makes contributions to The Rotary Foundation easy. With TRF-DIRECT (Electronic Fund Transfer) you ll be able to: Support the programs of The Rotary Foundation Choose your most convenient means of contributing (checking, savings, credit card) TRF Choose your amount and recurring contribution timeline (monthly, quarterly, annually) Automate your giving and easily DIRECT reconcile your bank or credit card statements and save on postage, check charges, and envelope costs If you use your Rotary MasterCard or American Express, you can also earn additional WorldPoints at the same time! TRF-DIRECT contributions count toward Rotary Foundation Sustaining Member, Paul Harris Fellow and Multiple Paul Harris Fellow, Paul Harris Society, and Major Donor recognition SIMPLE SAFE TRF-DIRECT Checking/Savings Account Authorization Name Address City State Phone Postal Code Rotary Club # District # Rotary Membership ID # q Non-Rotarian Credit Rotary Club of Banking Information Name of Bank City State Bank Account Number Bank Routing Number Postal Code Account Type: q Checking (include a voided check) q Savings (include a deposit slip) Minimum US$10 per transaction I hereby authorize The Rotary Foundation to deduct US$ on (choose one below) q 1st of every month q 15th of every month q 1st of every quarter q Annually (specify month: ) from the bank account indicated above. I understand that each transaction will appear on my regular bank statement. I further understand that it is my responsibility to notify The Rotary Foundation if there are any changes to my bank account that will affect my TRF-DIRECT participation. This authority remains in effect until I notify The Rotary Foundation in writing and the Foundation has had a reasonable amount of time to fulfill my request. The Rotary Foundation can terminate this agreement at any time.

5 TRF-DIRECT Credit Card Authorization Connect Name Address City State Postal Code Phone Rotary Club # District # Rotary Membership ID # q Non-Rotarian Credit Rotary Club of Credit Card Information Please charge my: (mark one below) q Visa q MasterCard q American Express 3-digit security code Account # Expiration The Every Rotarian, Every Year effort is aimed at encouraging Rotarians worldwide to participate fully in the mission of Rotary through their ideal of service and their generosity to support the programs and works of Rotary around the world! TRF DIRECT DONATIONS I hereby authorize The Rotary Foundation to charge US$ (minimum US$25 per transaction) on (choose one below) q 1st of every month q 15th of every month q 1st of every quarter q Annually (specify month: ) THANK YOU FOR YOUR SUPPORT! from the credit card indicated above. I understand that each transaction will appear on my regular credit card statement. I further understand that it is my responsibility to notify The Rotary Foundation if there are any changes to my credit card account that will affect my TRF-DIRECT participation. This authority remains in effect until I notify The Rotary Foundation in writing and the Foundation has had a reasonable amount of time to fulfill my request. The Rotary Foundation can terminate this agreement at any time. The Rotary Foundation of Rotary International TRF-DIRECT, FD420 One Rotary Center 1560 Sherman Avenue Evanston, IL USA Phone: Fax: EN-USA (108) Direct

6 Connect... Support the educational and humanitarian programs of The Rotary Foundation! Become a Rotary Foundation Sustaining Member! ($100 annually) $10 per month helps provide tuition and books for one year of school for two children in Sri Lanka $25 quarterly helps provide cataract operations for three blind individuals in India Become a Paul Harris Society Member! ($1,000 annually) $100 per month helps provide materials to construct a deep borewell in Kenya, supplying clean water to more than 300 people $250 quarterly helps provide parasite and anemia prevention materials for needy children in Uruguaiana, RS, Brazil CONVENIENT Direct... TRF-DIRECT makes contributions to The Rotary Foundation easy. With TRF-DIRECT (Electronic Fund Transfer) you ll be able to: Support the programs of The Rotary Foundation Choose your most convenient means of contributing (checking, savings, credit card) TRF Choose your amount and recurring contribution timeline (monthly, quarterly, annually) Automate your giving and easily DIRECT reconcile your bank or credit card statements and save on postage, check charges, and envelope costs If you use your Rotary MasterCard or American Express, you can also earn additional WorldPoints at the same time! TRF-DIRECT contributions count toward Rotary Foundation Sustaining Member, Paul Harris Fellow and Multiple Paul Harris Fellow, Paul Harris Society, and Major Donor recognition SIMPLE SAFE TRF-DIRECT Checking/Savings Account Authorization Name Address City State Phone Postal Code Rotary Club # District # Rotary Membership ID # q Non-Rotarian Credit Rotary Club of Banking Information Name of Bank City State Bank Account Number Bank Routing Number Postal Code Account Type: q Checking (include a voided check) q Savings (include a deposit slip) Minimum US$10 per transaction I hereby authorize The Rotary Foundation to deduct US$ on (choose one below) q 1st of every month q 15th of every month q 1st of every quarter q Annually (specify month: ) from the bank account indicated above. I understand that each transaction will appear on my regular bank statement. I further understand that it is my responsibility to notify The Rotary Foundation if there are any changes to my bank account that will affect my TRF-DIRECT participation. This authority remains in effect until I notify The Rotary Foundation in writing and the Foundation has had a reasonable amount of time to fulfill my request. The Rotary Foundation can terminate this agreement at any time.

7 Please process my gift for: THE ROTARY FOUNDATION OF ROTARY INTERNATIONAL CREDIT CARD CONTRIBUTION FORM Please print or type o US$100 o US$250 o US$500 o US$1000 o other, US$ Designation: o Annual Programs Fund o Permanent Fund o PolioPlus o Polio Plus Partners Gifts to the Annual Programs Fund and the World Fund are eligible for Paul Harris Fellow recognition. Gifts to the Permanent Fund are eligible for Benefactor recognition. Please attach a RF3-123 Form (Recognition/Contribution form) if you would like to request recognition at this time. If you do not make a designation for your gift, it will be applied to the Annual Programs Fund. Please charge my: o Visa o Mastercard o Diner s Club o American Express Account #: Expiration : / (Month / Year) : Today's : My name (as it appears on my credit card) My address City State/Prov. Zip Code/Postal Code Country Daytime Telephone # I am a member of the Rotary Club of Club # District TRF Account # Your completed Credit Card Contribution Form may be sent by fax to: , Attention: Development Services (Please send only once. If you send duplicate requests, your credit card may be charged twice) Gifts to The Rotary Foundation are tax deductible where permissible by law.

8 Please process my gift for: THE ROTARY FOUNDATION OF ROTARY INTERNATIONAL CREDIT CARD CONTRIBUTION FORM Please print or type o US$100 o US$250 o US$500 o US$1000 o other, US$ Designation: o Annual Programs Fund o Permanent Fund o PolioPlus o Polio Plus Partners Gifts to the Annual Programs Fund and the World Fund are eligible for Paul Harris Fellow recognition. Gifts to the Permanent Fund are eligible for Benefactor recognition. Please attach a RF3-123 Form (Recognition/Contribution form) if you would like to request recognition at this time. If you do not make a designation for your gift, it will be applied to the Annual Programs Fund. Please charge my: o Visa o Mastercard o Diner s Club o American Express Account #: Expiration : / (Month / Year) : Today's : My name (as it appears on my credit card) My address City State/Prov. Zip Code/Postal Code Country Daytime Telephone # I am a member of the Rotary Club of Club # District TRF Account # Your completed Credit Card Contribution Form may be sent by fax to: , Attention: Development Services (Please send only once. If you send duplicate requests, your credit card may be charged twice) Gifts to The Rotary Foundation are tax deductible where permissible by law.

9 Yes, I/we would like to become a member(s) of The Rotary Foundation Bequest Society. This is a JOINT bequest and both spouses names should appear on the crystal. Name(s) (Please print/type name[s] as you wish it to appear on the crystal.) Address (Street) (City, state and zip code) District Rotary Club (s) of Birth (husband) (wife) Telephone (Home) (Business) I designate that the spending portion of my gift will be applied: at the Trustees discretion (World Fund) through SHARE (District Designated Fund and World Fund) to the Children s Fund (World Fund) to the Rotary Centers for International Studies My Bequest will be funded by: Will Living Trust Life Insurance Charitable Remainder Trust* IRA/401(k)/Retirement Plan Other The amount to The Rotary Foundation will be (The anticipated amount is necessary to establish recognition level.) % and/or US$ I have opted to mail a copy of my: Will Trust Life Insurance Policy for retention at The Rotary Foundation (FN300), One Rotary Center, 1560 Sherman Avenue, Evanston, IL USA Please do not list my name in any publications or reports.** *Gifts made through a Charitable Remainder Trust count towards Major Donor recognition. **The Rotary Foundation appreciates information about commitments. Your name and level may be published to inspire others unless you check the box above. We recognize the personal nature of these commitments and assure that the details will be kept confidential.

10 Yes, I/we would like to become a member(s) of The Rotary Foundation Bequest Society. This is a JOINT bequest and both spouses names should appear on the crystal. Name(s) (Please print/type name[s] as you wish it to appear on the crystal.) Address (Street) (City, state and zip code) District Rotary Club (s) of Birth (husband) (wife) Telephone (Home) (Business) I designate that the spending portion of my gift will be applied: at the Trustees discretion (World Fund) through SHARE (District Designated Fund and World Fund) to the Children s Fund (World Fund) to the Rotary Centers for International Studies My Bequest will be funded by: Will Living Trust Life Insurance Charitable Remainder Trust* IRA/401(k)/Retirement Plan Other The amount to The Rotary Foundation will be (The anticipated amount is necessary to establish recognition level.) % and/or US$ I have opted to mail a copy of my: Will Trust Life Insurance Policy for retention at The Rotary Foundation (FN300), One Rotary Center, 1560 Sherman Avenue, Evanston, IL USA Please do not list my name in any publications or reports.** *Gifts made through a Charitable Remainder Trust count towards Major Donor recognition. **The Rotary Foundation appreciates information about commitments. Your name and level may be published to inspire others unless you check the box above. We recognize the personal nature of these commitments and assure that the details will be kept confidential.

11 Bequest Society M E M B E R S H I P C A R D Personal and Confidential Foundation The Rotary BEQUEST SOCIETY CRYSTAL Send the completed Membership Card to: The Rotary Foundation (FN300) One Rotary Center 1560 Sherman Avenue Evanston, IL USA Or fax to: Level One Two Three Four Five Six Commitment Range US$10,000-$24,999 US$25,000-$49,999 US$50,000-$99,999 US$100,000-$499,999 US$500,000-$999,999 US$1,000,000 Plus Recognition Items One-Diamond Pin plus Bequest Society Crystal Two-Diamond Pin plus Bequest Society Crystal Three-Diamond Pin plus Bequest Society Crystal Four-Diamond Pin plus Bequest Society Crystal Five-Diamond Pin plus Bequest Society Crystal Six-Diamond Pin plus Bequest Society Crystal For more information, visit the RI Web site: EN (704)

12 FACT SHEET INTRODUCING THE ROTARY FOUNDATION BEQUEST SOCIETY At their October 1999 meeting, The Rotary Foundation Trustees approved the adoption of a bequest recognition society, The Rotary Foundation Bequest Society. Becoming a member is a simple process. Membership occurs when an individual or a couple place The Rotary Foundation in their estate plan for a minimum of US$10,000 and notify The Foundation. Open enrollment for membership to The Rotary Foundation Bequest Society, to include previous Benefactors who qualify for the Bequest Society, began in April By completing a Bequest Society membership card and sending it to The Rotary Foundation, a donor will be recognized according to the following levels: LEVEL CONTRIBUTION RANGE US$10,000 - $ 24,999 US$25,000 - $49,999 US$50,000 - $99,999 US$100,000 - $499,999 US$500,000 - $999,999 US$1,000,000 Plus RECOGNITION ITEMS CRYSTAL 1 Diamond Pin CRYSTAL 2 Diamond Pin CRYSTAL 3 Diamond Pin CRYSTAL 4 Diamond Pin CRYSTAL 5 Diamond Pin CRYSTAL 6 Diamond Pin A new, single size, bequest society recognition crystal will be given. A Diamond Circle pin, corresponding to the appropriate contribution range as identified above, will also be presented. The following gift types of US$10,000 or more are eligible for Bequest Society Membership: Bequest commitments (e.g. Wills, Living Trusts, Retirement Plan assets) Whole and Universal Life Insurance Additional Information Term Life Insurance does not qualify for Bequest Society membership. Cash, other outright contributions, and life income agreements of US$10,000 receive Major Donor recognition. Spouses do not automatically qualify and will need to submit their own commitment if the application does not specify a joint bequest. Diamond Circle pins will reflect the combined totals from personal outright contributions as well as bequest commitments. Crystal recognition will remain separate and reflect the total dollars given under each respective Major Donor and Bequest Society recognition program. Benefactor or Bequest Society Member? The introduction of the new Rotary Foundation Bequest Society will not directly alter Benefactor recognition. For those individuals who identify bequest commitments and life insurance policies ranging from US$1,000 to US$9,999, Benefactor recognition will be awarded. However, because their estate plan commitment is under the US$10,000 threshold for Bequest Society recognition, membership will not be awarded. Individuals who identify bequest commitments and unpaid whole and universal life insurance policies US$10,000 or over, will be awarded both benefactor recognition and be eligible for membership in the Bequest Society.

13 UPDATE ON MAJOR DONOR RECOGNITION During their October 1999 meeting, The Rotary Foundation Trustees revised the Major Donor recognition. Originally set at five levels, the Trustees approved the addition of a new level (US$25,000 49,999) that now brings the total to six levels. A new pin design was approved that allows the inclusion of up to six Diamonds to reflect the respective giving levels. Please refer to the chart below for a detailed explanation of each level, the appropriate Diamond Circle pin and a picture of the six different crystals. Recognition occurs when an individual or a couple has contributed a combined personal outright gift(s) of US$10,000 or more to The Rotary Foundation. Please note that the Diamond Circle pins now identify recognition levels for both the Major Donor program and the new Bequest Society. However, crystal recognition will remain separate and reflect the total dollars given under each respective Major Donor and Bequest Society recognition program. LEVEL CONTRIBUTION RANGE US$10,000 - $ 24,999 US$25,000 - $49,999 US$50,000 - $99,999 US$100,000 - $499,999 US$500,000 - $999,999 US$1,000,000 Plus RECOGNITION ITEMS Level 1 CRYSTAL 1 Diamond Pin Level 2 CRYSTAL 2 Diamond Pin Level 3 CRYSTAL 3 Diamond Pin Level 4 CRYSTAL 4 Diamond Pin Level 5 CRYSTAL 5 Diamond Pin Level 6 CRYSTAL 6 Diamond Pin Major gifts can be given in a variety of ways: cash, pledges and planned gifts. They can be made to the Annual Programs Fund or the Permanent Fund. In either case, the donor may opt to designate the gift to the SHARE District Designated Fund (DDF) or the Trustee-directed World Fund (WF). Donors are always asked how they would like their funds used. A gift that is not further designated provides maximum flexibility for future programs needs. However, opportunities exist for donors who may wish to designate their gifts to a particular type of program or a specific geographic area. Recognition for all irrevocable life insurance policies (owned by and payable to The Rotary Foundation), which are written on the life of an adult donor (over 21 years old), shall be based on the greatest determinable value of such policies (usually the face value ) as long as the minimum cash value is US$1,000. Donors whose cumulative contributions are US$250,000 or more may opt to have their photograph permanently displayed in the Rotary Hall of Honor at World Headquarters in Evanston, Illinois. Major Donors are invited to the annual Trustee Chairman s Appreciation Dinner that is held in conjunction with the Rotary International Convention and are listed in the Salute to Donors booklet that is published annually.

14 Your legacy will make a lasting difference in the world The Permanent Fund builds long-term stability for the future of The Rotary Foundation of Rotary International by providing an extra stream of income to meet an increasing demand for the Foundation s educational, humanitarian, and cultural programs. We invite you to invest in tomorrow by joining Rotarians in their efforts to improve and enrich lives of people around the globe. A Benefactor of The Rotary Foundation is anyone who informs the Foundation in writing that he or she has made provisions in his or her will, or other estate plan, naming the Foundation s Permanent Fund as a beneficiary; or anyone who makes an outright gift of US$1,000 or more to The Rotary Foundation Permanent Fund. The Rotary Foundation appreciates information about commitments from which it will benefit in the future. We recognize the highly personal nature of these commitments. Unless we receive other directions from you, Benefactor recognition will be sent to your club president. Pictured above is the Benefactor insignia behind a Paul Harris Fellow lapel pin. The Trustees are grateful for your gift and for your permission to publish your name as a Benefactor so that your example may inspire others EN (1006) B E N E F A C T O R G I F T C O M M I T M E N T I expect my gift will amount to US$.* *Bequest commitments of US$10,000 or more qualify you for membership in the Bequest Society. Additional information on the Bequest Society can be obtained at My Benefactor commitment to The Rotary Foundation s Permanent Fund will be in the form of: Will/Bequest Outright gift Other (please specify) I designate that the spending portion of my gift will be applied*: at the Trustees discretion (World Fund) through SHARE (District Designated Fund and World Fund) *Should no designation be specified, the Trustees will use it for programs supported by the World Fund. Name District Rotary Club Please print or type name as you wish it to appear on the Benefactor certificate. Address Telephone of Birth Please return this bottom portion of the card to the appropriate address listed on reverse side. / / Day Month Year

15 Can you imagine a world where peace flourishes? A World f r e e f r o m h u n g e r f i l l e d w i t h n e w i d e a s w h e r e d i s e a s e i s d e f e a t e d w i t h m u t u a l r e s p e c t a m o n g a l l f a i t h s, r a c e s, a n d c u l t u r e s Send Benefactor card, checks, or money orders to appropriate address below*: Canada The Rotary Foundation (Canada) Box B9322 P.O. Box 9100 Postal Station F Toronto, ON M4Y 3A5 Canada Europe and Africa Rotary International Witikonerstrasse 15 CH-8032 Zurich Switzerland Great Britain and Ireland Rotary International Kinwarton Road Alcester, Warwickshire England B49 6PB South Asia Rotary International Thapar House 2nd Floor, Central Wing 124 Janpath New Delhi India South Pacific/ Philippines Rotary International McNamara Centre 2nd Floor 100 George Street Parramatta, NSW Australia 2150 United States The Rotary Foundation Collections Center Drive Chicago, IL USA *In countries with currency restrictions or an RI Fiscal Agent, please contact your district Rotary Foundation chair for the address to send contributions EN (1006)

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