EACH MEMBER ATTENDING, LION, LIONESS, LEO , GOLFERS OR GUEST
MUST FILL OUT AN INDIVIDUAL REGISTRATION FORM
□ Central
□ Northern
□ Southern
NAME: _______________________________________ CLUB NAME: ____________________ZONE:_________ □ Western
PLEASE PRINT AND FILL OUT ALL INFORMATION
ADDRESS ___________________________________CITY: ________________________CA ZIP CODE: _______________
PHONE (
)_______________________________ EMAIL ADDRESS: __________________________________________
OFFICE IN LIONISM: PLEASE CHECK YOUR HIGHEST POSITION AND FIRST TIMER OR MELVIN JONES FELLOW
□INTERNATIONAL OFFICER (PAST OR PRESENT) □DG □PCC □1ST VDG □2ND VDG □PDG □CABINET MEMBER
□14-15 CLUB PRESIDENT
□LION □LIONESS □LEO □GUEST □FIRST TIMER
Extra 3rd Cabinet Pin $3.00 ea.
3rd District Meeting Total Package Includes:
Registration, Pin, Friday’s Dinner, Saturday’s Coffee
and tea, and Saturday’s Lunch
NO REFUNDS AFTER 1/16/15
Registration (All Attending)
Postmark Before
Jan. 16, 2015
LIONS & Lioness
$10.00 ea
Friday 1/30: BBQ Tri Tip Dinner with beans, green salad,
bread and dessert
Saturday 1/31: (Morning) Coffee and Tea
Saturday 1/31: Light lunch of sandwiches, chips, cookies
and a drink
Postmark After
Jan. 16, 2015
$40.00 ea
$
.00
$55.00 ea $
.00
$
.00
$25.00 ea $
.00
LEO’s
$10.00 ea
$20.00 ea
Included
$15.00 ea
included
Included
$20.00 ea $
.00
TOTAL $
.00
Golf: Friday at 9 AM (Separate Registration)
Friday: Sports Theme (Come in your favorite team colors)
Friday: Hospitality & Fellowship…………………………………..:
Friday: PDG Meeting ………………………………………………….:
Friday: District 4-A2 Dinner ………………………..……………...:
Sat. : Board Meeting - GMT & GLT Meeting ..……………..:
Registration ..………………………………………………….:
Cabinet Meeting (Uniform Dress) ……………………..:
Sat. : Lunch Will Be Served At ………...………………...…….:
□MELVIN JONES FELLOW
5:30 - 6:30 pm
6:00 pm
7:00 pm
8:00 am - 9:00 am
8:30 am
9:00 am - 2:00 pm
12:00 pm
NOTICE: Meal Pre-Registration MUST be postmarked NO LATER THAN, January 15, 2015
Make checks payable to “Lions District 4 A-2” and mail with this registration form to:
Cabinet Treasurer: Jan Beatty-Taylor - 710 North Vista, Visalia CA 93292
559-909-1817 or Email: [email protected]
Comfort Inn & Suites, 40820 Sierra Drive, Three Rivers, CA 93271
(559) 561-9000; email: [email protected]. Mention "Lions Club" for special rate of
$71.10 plus Tax per night for room with 2 queens. (Full breakfast provided at Comfort Inn)