Name & Date:  

PEABODY LIONS Application for Membership

For Membership information, please complete the following form and email to info@peabodylions.org or mail to:

THE PEAODY LIONS

300 Andover Street, Suite 111

Peabody, MA 01960

Member Sponsor: ____________________________________________

First Name: ________________ MI: ___ Last Name: _________________

Gender:  Male     Female     Occupation: ______________________

Date of Birth: ______________  Spouses Name: _____________________

Address: __________________________________________________

City: _____________________  State: ______ Zip: ________________

Primary Telephone: __________________

Cell Phone: _________________________

E-Mail: _________________________________________________

I am a:    New Member    Former Member

 Transfer Member -  Member Number:________________

Previous Club Name: ____________________ 
Previous Club Number: ______________

Enclosed is $100.00 entrance fee.   This includes a new member kit, vest, visor, monthly magazine and registration fees for membership in The International Association Of Lions Clubs.  Annual Dues are $100.00 and billed semi-annually. ($50.00 June and December).

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: _________

LIONS Mission Statement

TO EMPOWER volunteers to serve their communities, meet humanitarian needs, encourage peace and promote international understanding through Lions Clubs.  WE SERVE!