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Rotarian Name (required)

Work Phone

Home Phone


Your Email (required)

(Email is the best way to communicate with everyone involved. If you do not have your own email address, please provide us with a friend’s address so that we may send you the necessary updates.)

Name of Rotary Club

Number of schools you wish to attend

(You may attend other schools during the month of April.)

I would like to help out on the following committees:

Organizing Committee

Oversee event organization

Loot Bag Committee

Collect contents of loot bags, assemble and distribute to schools

PR Media Committee

Prepare News Releases, Invite media to event, Invite politicians and guests; Arrange interviews; Arrange Public Service Announcements; Promote Brush-a-mania throughout Ontario. (Place posters in libraries, rec centres, etc.)


Contact Sponsors for money, prizes, product or services.


Recruit/follow-up with schools, dentists, Rotarians.

For more information, contact Rotarian Ron Manfield for assistance at: or 416-248-4952.