High Point Lions Club
New Member Application
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
*
Please Select
Facebook / Social Media
Friend / Family Member
Lion Member
Newspaper
Other
Please Specify
*
Why would you like to join the Lions Club:
Do you currently live or plan on living in High Point?
Yes
No
Please list anyone else who might be interested in joining the High Point Lions Club. (optional)
Rows
Full Name
Address
Contact Number
1
2
Submit
Should be Empty: