Lions Club Membership Application
Your Name
*
Member Sponsor (if you have one)
Email
*
Cell Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Date of Birth
*
Spouse's Name
Gender
*
Male
Female
Club Name that you are interested in joining.
I am a
New Member
Former Member
Transfer Member
If you are a transfer member, what is your member number?
Previous Club Name
Previous Club Number
Submit
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