SAN MATEO COUNTY FIRST RESPONDER MEMBERSHIP APPLICATION

Download the fillable PDF application form located in the DOCUMENTS section

Lions Club Name: SAN MATEO COUNTY FIRST RESPONDERS LIONS CLUB 

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

           ¨  Family Member (Requires a TK-30)      ¨ Associate Member      ¨ Affiliate Member

           ¨Former Member   ¨Transfer Member      Member Number: _____________________

        (If unknown, email stats@lionsclubs.org)

Previous Club Name:________________________ Previous Club Number: ___________

New Member: Enclosed is $35.00  as an entrance fee, in addition to $ 125.00 for International, Multiple District, District and Club dues. Other Applicants: Please contact the Club for fees.

I accept membership into Lions Clubs InternationalLC@GMAIL.COM 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:_____________________

SUBMIT APPLICATION TO CLUB SECRETARY AT: membership.smcfrlc@gmail.com