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Contact Information
Note: Your credit card statement will display the name Bambora for this payment.
Your Information
First Name
:
Last Name
:
Street Address for Flag
:
City
:
Postal Code
:
Email
:
Phone
:
Are there underground sprinklers at the front of the yard?
:
Yes
No
Is the flag a gift for someone?
:
Yes
No
If it is a gift, enter their name
:
Is the flag to honour a past or present member of the Armed Forces?
:
Yes
No
Past or Present Member of the Armed Forces?
:
-- -- Please Select -- --
Past
Present
Enter the rank, first name, and last name. Add $20 to the payment for the lawn sign that will be placed beside the flag pole
:
How did you learn about our Fly the Flag with Rotary fundraiser?
:
-- -- Please Select -- --
Rotary member
CHAB radio
Discover Moose Jaw online
Moose Jaw Express
Moose Jaw Today online
Facebook
Lawn sign
Flag pole label
Other
I consent to the collection, storage, and use of my information by Rotary Club of Moose Jaw Wakamow as described in this
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