2017 Registration Form

Title

Name

First and Last Name

Club Name

District

First Lions Convention?

YesNo

Title

Name

First and Last Name

Club Name

District

First Lions Convention?

YesNo

Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Include Area Code

E-mail Address

EARLY REGISTRATION DEADLINE IS APRIL 15, 2017

Late registration fee (after April 15th): $45.00 per person

SO MAKE SURE YOU REGISTER EARLY!

Lions members must be registered to vote, be a vendor, or attend any function of the convention.

Select each event you will attend and the total number of attendees.

Early Registration Fee $30.00

Number of Attendees
Item subtotal:$0.00

Late Registration Fee$45.00

Number of Attendees
Item subtotal:$0.00

Friday Luncheon$25.00

Number of Attendees
Item subtotal:$0.00

Friday Night Dinner$44.00

Number of Attendees
Item subtotal:$0.00

Saturday Breakfast with the Eye Bank$ Free

Number of Attendees
Item subtotal:$0.00

Saturday Luncheon$25.00

Number of Attendees
Item subtotal:$0.00

Saturday Dinner$44.00

Number of Attendees
Item subtotal:$0.00

Total $0.00

Dietary restrictions:

For more information, please contact

Lioness Carol Louks at: (720) 542-8700 or e-mail at: md6lions@gmail.com

or Lion Fletcher Brown at: (303) 619-8486 or e-mail: 2017colions@gmail.com

Make checks payable to: Lions State Convention Fund and mail with this form to: Lion Carol Louks - 4266 W. Pondview Drive, Littleton, Colorado, 80123

Or register online at http://www.colions.org and pay with PayPal or a Credit Card!