|
MEMORIAL SERVICE
DISTRICT 2-A2 LIONS
2011-2012
NAME _______________________________ LIONS CLUB _______________________________________________________
JOINED LIONS ____________ CLUB ___________________________________________ CHARTER MEMBER (Y/N)___________
OTHER CLUBS____________________________________________________________________________________________
CLUB OFFICES HELD: _____________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
DISTRICT OFFICES HELD:__________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
STATE OFFICES HELD: _____________________________________________________________________________________
__________________________________________________________________________________________________________
INT’L OFFICES HELD: ______________________________________________________________________________________
AWARDS IN LIONISM______________________________________________________________________________________
__________________________________________________________________________________________________________
COMMUNITY ACTIVITIES_________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
NEXT OF KIN:_____________________________________________________________________________________________
Address (street/box)___________________________________________________ City _____________________________
State________________ Zip__________ E-mail_____________________________________________________________
OTHER COMMENTS:_______________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Please provide name of Member who will be your Club Representative for Memorial Service________________________________
Important:
Send photo of deceased Lion. If available, send more than one so I can select; various poses ok. Digital; Color or Black & White.
Will you want photos back? Yes_____________ No__________
Additional information may be written on the back.
Send to: PDG Lytle H. Blankenship, District 2-A2 Chaplain, 4410 Medina Hwy, Kerrville, TX 78028; lhblanken@gmail.com
|
