Lions Club Name:______________________________  Sponsor:______________________

 

Name: First___________________ M:____ Last __________________________ Suffix: ____

 

Gender: Male ___     Female___    Non-Binary___    Prefer not to Answer ___   

 

Occupation _________________________________ 

 

Date of Birth:_____________________ Spouse’s Name:_____________________________

 

Address:___________________________  City:______________State:______Zip:________

 

Phone:_____________________ Email:__________________________________________

 

I am a: New Member _____   Transfer Member ______   Member Number _______________ 

 

Previous Club:_______________________________________ Club Number:____________

 

Entrance Fee: $____________   International, Multiple District, District Dues: $____________

 

I accept membership into Lions Clubs International and that the standards are limited to persons of good moral character and reputation.  I recognized the importance of rendering personal service to my community in corporation with other civic-minded persons.  I understand that membership is not valid until approved by the club’s board of directors.

 

 

Signature:_____________________________________________________________________

 

 

 

 

FOR CLUB SECRETARY USE

I confirm that the board of directors has approved this member for membership in this Lions club.

 

Signature of Club Secretary:_______________________________________________________

 

OUR MISSION

To empower volunteers to service their communities, meet humanitarian needs, encourage peace and promote international understanding though Lion clubs.