Form to Donate Via Cash or Check

You may submit this form if you wish to donate using cash or check directly to a Rotary Club of Poipu Beach club member instead of using a credit/debit card online.


Please enter one or both

Depending on what communiction method(s) you selected above, you must enter either email address or phone number or both below.

Note: We must be able to contact you via one of these methods in order for you to win the prize.


Have a question?

Feel free to ask a question or simply leave a comment.


NOTE: You will see a message on the screen when your form has been successfully submitted. If you do not see that message, it has not been sent.