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OMEGA APPLICATION FOR LEOS CLUB MEMBERSHIP

OMEGA APPLICATION FOR LEO CLUB MEMBERSHIP
As the Omega Leo Club Program is designed for young adults ages 18-30, this form is intended to be completed by
new Leo members who are over the age of legal majority, up to the age of 30. New Leos who have not yet reached
legal age of majority should complete the Alpha Application for Leo Club Membership (Leo50-A). Because it is the
responsibility of the sponsoring Lions club to maintain records on Leo new member consent, this form should be
completed and returned to your Leo club secretary or Leo club advisor who is a member of the sponsoring
Lions club. Completed forms should be kept on file with the sponsoring Lions club; 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. I understand that the entrance fee will be ____________and the annual dues will
be . I also understand that, pending my consent, my personal data will be entered into Lions Clubs
International member databases and used to facilitate communications with and between LCI members. The
consent section can be found on the second page of this form.

SIGNATURE OF APPLICANT DATE

Leo50-O 1/14 Please complete both sides of this form
264 WE BELIEVE