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ALPHA APPLICATION FOR LEOS CLUB MEMBERSHIP

ALPHA APPLICATION FOR LEO CLUB MEMBERSHIP
Both pages of this form must be completed for all Leos under the legal age of majority and returned to the Leo
club advisor who is a member of the sponsoring Lions club. Because it is the responsibility of the sponsoring
Lions club to maintain records on parental/guardian consent for any young person under the legal age of majority
who joins a Leo club, it is imperative that this completed form be kept on file with the sponsoring Lions club.
Completed forms should not be sent to International Headquarters.

SECTION I: APPLICANT INFORMATION

First (Given) Name Middle Name

Last (Family) Name

Street Address

City State Postal Code

Country

Preferred Phone E-mail

Gender Year of Birth
Other organizations
of which I am a member

I am a: New Member How did you hear about the Leo club?

Transfer Member Former Member Member Number
(If unknown, e-mail leo@lionsclubs.org)

Previous Club Name Previous Club Number

SECTION II: APPLICANT SIGNATURE

I, the undersigned, am in good standing in my school and/or community, and in accordance with the constitution
and bylaws of this club, hereby apply for membership in the Leo Club,
sponsored by the Lions Club. I believe the above information to be true
and complete, and I desire membership in this club. I believe I can make a contribution to the club and be worthy of
the friendship of its members. My parent(s)/guardian(s) and I understand that the entrance fee will be __________
and the annual dues will be . I also understand that, pending parental/guardian consent, my personal
data will be entered into Lions Clubs International member databases and used to facilitate communications with
and between LCI members. Parental/guardian consent section can be found on the second page of this form.

SIGNATURE OF APPLICANT DATE

SECTION III: FOR LIONS USE ONLY

Copy of completed application added to Leo club’s files Leo added to club roster via MyLCI

Parental/Guardian consent received Parental/ Guardian consent approved via MyLCI

APPROVED BY DATE
Leo Club Advisor Signature

Leo-50A 1/13 Please complete both sides of this form
WE BELIEVE 263