Club Membership Registration Form

Lions Share Club Membership Registration Request

Complete the form below to sign up for our membership service.
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date

MonthDayYear
Membership Type you are interested in:

Individual (Optional Monthly or Annual Membership)Business (Monthly or Annual Membership)Bronze(Costs may apply)Silver(Costs may apply)Gold (Costs may apply)
Preferred way to contact*

PhoneEmailAnyPlease do not contact me
Select Charities you are interested in:*

Nevada Childhood Cancer Foundation (NCCF)UMC Burn UnitLions Camp Lotza FunLions Camp Dat-So-La-LeeLions Club International FoundationLions SightFirst Foundation of Southern NevadaOther
Charity Events you are interested in:*

Black Mountain Poker TournamentLions Camp Lotza FunLions Camp Dat-So-La-LeeSpring Fling - 2024Eyeglass recycling effortsOther
I would like to obtain more information about:

VolunteeringDonatingUpcoming Events or activitiesJoining a local Lions chapterEyeglass Donation Location
Membership Rules
1. Membership is available to anyone 18 years of age or older.
I have read, understood, and accepted the rules for membership.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
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Lions Share Club Membership Registration Request