Membership Application -- Please print and submit completed application and dues to the Club Secretary

I hereby apply to become a MEMBER of the Pendleton Lions Club which is chartered and affiliated with the International Association of Lions Clubs and agree to conform to the Constitution and Bylaws of said club.

NAME ___________________________________________________

Sponsor __________________________________________________

New Member   Y   N         Transfer Y   N

Gender   M     F

Membership Type/ Annual Dues*: General/ $75 Family $75 + $35   Student $20   Checks should be made out to the Pendleton Lions Club. 

Street address ____________________________________________

Mailing address ___________________________________________

City _________________________ State ____ Zip __________

e-mail_______________________________________________

Home Phone   ________-_____-_________ Unlisted Y N

Cell Phone       ________-_____-_________

DOB MM/DD/YYYY _______________________

*DUES:  includes membership in the Pendleton Lions Club, the Oregon Lions, and Lions International including subscriptions to their respective publications.  A club vest will be presented at the member’s induction. Dues checks should be made out to the Pendleton Lions Club. 

If transferring from another club, please provide the name of the previous club and district.

_____________________________________________________

Special interests, skills, resources __________________________________________________________________________________________________________Applicant Signature  /  Date _________________________________________________________________