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International Fellowship of Scouting Rotarians - IFSR membership application 2005 11 01

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International Fellowship of Scouting Rotarians - IFSR membership application 2005 11 01
INTERNATIONAL FELLOWSHIP OF SCOUTING ROTARIANS (IFSR)
MEMBERSHIP APPLICATION


Please Check appropriate boxes:
I am now an IFSR member
I wish to join the IFSR
Renewal
$20 New Member
$25 (IFSR pin)
Associate
$25

Life Member
$200 (IFSR pin) & check ONE below
Blue Tie
Green Tie
Maroon tie
Scarf
Neckerchief
Name_____________________________________________________________________________
Address___________________________________________________________________________
City______________________________________ State_______________________
ZIP/Postal Code__________________ Country______________________________
Email_________________________________________________________________
Phone(H)__________________________________(W)____________________________________

Rotary Club___________________________________________ Rotary District______________

Present Scouting position, if any_______________________________________________________
Rotary Classification_________________________________________________________________

I would like to serve as an IFSR officer
IFSR Committee member
IFSR District Coordinator
How else may I help?

Please send me information on: Eagle Scout Certificate
The Cliff Dochterman Award
Make checks payable $USD to: INTERNATIONAL FELLOWSHIP OF SCOUTING ROTARIANS
Make checks payable $USD to "IFSR"
TOTAL SUBMITTED $USD __________________
If you would prefer payment by credit card, fill in the information below.
CREDIT CARD
VISA
MC
CARD #
EXP DATE
NAME ON CARD _________________________________________________________
CREDIT CARD BILLING STREET ADDRESS___________________________________________________________ ZIP CODE_________________
SIGNATURE _________________________________________________________ Billing appears as "R & S Meeting Management"
In UK(RIBI), send Pounds Sterling to:
Ken Scott
Pinewood, 2A Manland Way
Harpenden, Hertfordshire, AL54QS
All countries except UK:
Send $USD to:
IFSR/IAR Executive Secretary
Tel:
(619) 461- 6338
P O BOX 19982
Fax:
(619) 465- 0338
SAN DIEGO CA 92159-0982
email:
randyseefeldt@sbcglobal.net





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