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, ST/Province, Zip Code	________________________________________ Business City, ST/Province, Zip Code
______________________________________ Home County	________________________________________ Business County
(______)_______________________________ Home Telephone No.	(______)_________________________________ Business Telephone No.
Candidate a former Member?   Yes   No	How long in present Occupation? ___________

 Reason for Leaving: _______________________________________________________________
 _________________________________________________________________________________
 Other Service Organizations Candidate a Member of: __________________________________
 _________________________________________________________________________________
 _________________________________________________________________________________
Enclosed is $ __________ as entrance fee, semi-annual dues, semi-annual international per capita tax,  and convention fee.  $2.375 U.S. or its equivalent of the above amount is for a six months subscription to  "THE LION" magazine.

Recognizing the importance of rendering personal service to my community in cooperation with other Civic- minded persons, and appreciating the opportunity afford me to enjoy the good fellowship and prestige of Lions Club International, I hereby accept membership.

 
__________________________________________                         ______________________
 Signature                                                                                          Date