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Get Incoming Interact Officer Data Form

Incoming Interact Officer Data Form All Interact clubs must submit this form annually by 30 June. Please mail completed forms to Rotary International Data Services IS500 One Rotary Center 1560 Sherman Avenue Evanston IL 60201-3698 USA or fax to 847 328-8554. Please print or type information Term of Office month/year to month/year District Number Interact Club Name as it appears on Interact Club Certificate of Organization Interact Club President Interact Club Adviser Permanent Interact Club Mailing Address City State or Province Country Postal Code Telephone Fax E-mail address one per club Internet address I give permission for the Interact club name and contact information to be listed in next years Interact Correspondence Exchange List. Yes No Type of Interact club check one school-based community-based Number of members male s total Date of club organization day/month/year Name s of sponsoring Rotary club s Rotary Club Name State or Province Country Please obtain the signature below before forwarding report to RI World Headquarters. Please print or type information Term of Office month/year to month/year District Number Interact Club Name as it appears on Interact Club Certificate of Organization Interact Club President Interact Club Adviser Permanent Interact Club Mailing Address City State or Province Country Postal Code Telephone Fax E-mail address one per club Internet address I give permission for the Interact club name and contact information to be listed in next years Interact Correspondence Exchange List. Yes No Type of Interact club check one school-based community-based Number of members male s total Date of club organization day/month/year Name s of sponsoring Rotary club s Rotary Club Name State or Province Country Please obtain the signature below before forwarding report to RI World Headquarters.

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  • rotary
  • Sponsoring
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