Paul Harris Fellow Requests

This form should be used for applying for a Paul Harris Fellow. Guidance notes to assist you with completing this form can be found by scrolling to the bottom of this page under Related Downloads. Please note that if you wish to send a contribution in with your PHF application, you cannot use the on-line form below but please print and complete a PHF request form and post it with your cheque to RIBI Headquarters, Kinwarton Road, Alcester, Warwickshire, B49 6PB.

Fields marked with a * are mandatory

Rotary Club of *:

District *:

RI Club no. *:

Rtn completing form *:

Your email address:

Daytime tel. no. *:

Name of Recipient *:

Recipient ID number:

Rotary Club of recipient:

District:

Recognition items requested:

Please tick if the recipient is deceased:

Approx. presentation date *:

Contribution details:

Paul Harris Recognition Items to Be Sent to:

RIBI Collection and Use of Personal Membership Data
As part of its effort to assist clubs and districts and facilitate communication with Rotarians, Rotary International in Great Britain and Ireland collects personal information about Rotary club members and their partners and associates where appropriate, to be used solely for the purpose of conducting business activities. Full details are available by contacting the RIBI Secretariat.

Rotary International in Great Britain and Ireland

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