INTERNATIONAL ASSOCIATION OF LIONS CLUBS
                                           INVITATION-APPLICATION FOR MEMBERSHIP

IN THE LIONS CLUB OF:______________________________________________________

Please Print:   ____ MR.  ____MRS. ____MISS. ____ MS.

__________________________________________________________________________
           First Name                  MI                     Last Name              Suffix               Nickname

_________________________________                  _________________________________
Spouse's Name                                                               Candidate's Employer

_________________________________                  _________________________________
Spouse's Occupation                                                      Candidate's Occupation/Title

_________________________________                  _________________________________
Home Address                                                                 Business Address

_________________________________                  _________________________________
Home City, State/Province, Zip Code                           Business City, State/Province, Zip Code

_________________________________                  _________________________________
Home Telephone Number                                             Business Telephone Number

_________________________________                  _________________________________
Home Fax Number                                                          Business Fax Number

_________________________________                  _________________________________
Home E-Mail                                                                     Business E-Mail
 

Date of Birth:_______________                                    __________________________________
                                                                                            Cell Phone No.

  
Send Mail:    __Home ____Business                           How long in present occupation? _______
 

I am a former Lion:    _____ Yes    ______No

Reason for Leaving:___________________________________________________________
___________________________________________________________________________

I am a member of another service organization.   _______ Yes  _______No
If yes, which ones? ____________________________________________________________
 

Enclosed is $________ as entrance fee, semi annual dues, semi annual international per capita tax and fee. $2.375 U.S. or its equivalent of the above amount is for a six month subscription to THE LION MAGAZINE.

I accept membership into Lions Clubs International.  I recognize the importance of rendering personal service to my community in cooperation with other civic-minded persons.  I appreciate the opportunity for membership offered to me by Lions Clubs International.

Signature___________________________________ Date ___________________