Contact Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Sponsorship Level *

Title Sponsor ($10,000)

Gardenia ($5,000)

Hibiscus ($2,500)

Plumeria ($1,000)

Other (enter amount below)

Commemorative Program Book Advertisement

Full page (5" X 8") $225

Half page (5" X 4") $125

Quarter page (5" X 2") $75

Payment Options *

Paypal (You will receive a payment request via paypal in your email)

Check (Payable to: Rotary Club of Kapaa Foundation)