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)
© Copyright 2025 ExpyDoc