Lions Club Name: __________________________________________________________________________ Member Sponsor: __________________________________________________________________________ First Name: ________________________MI: _____ Last Name:________________ Suffix:____________ Gender: Male Female Occupation: __________________________________________________ Date of Birth: ______________________________Spouse’s Name: ________________________________ Address: __________________________________________________________________________________ City: ______________________________State: ________Zip:______________Country: ______________ Phone: ____________________________Email: ________________________________________________ Please review qualification criteria and fees for the following: I am a: New Member Former Member Transfer Member Member Number: __________________________ (If unknown, email firstname.lastname@example.org) Previous Club Name:________________________________Previous Club Number: ____________ Family Member Student Member Current or Former Leo Young Adult
Enclosed is $__________as an entrance fee, in addition to $ __________for international, multiple district, district and club dues. I accept membership into Lions Clubs International and that the standards are limited to persons of good moral character and reputation. I recognize the importance of rendering personal service to my community in cooperation with other civic-minded persons. I understand that membership is not valid until approved by the club’s board of directors.
Signature:_________________________________________________ Date:________________________Type your paragraph here.