DEATH OF A ROTARIAN

(This form will submit this information to the District Secretary who will inform the District Governor, Editor, District Officers and Clubs)
The District Secretary will also send a card of condolence to the widow/widower on behalf of the District.

Club Name
Your Name
Your Telephone Number
Deceased
Surviving
Their Name
Address
Was the club member?	Founder Member
	Past President
	Paul Harris
Funeral Details or message
Please check details before submitting