Lions Clubs International

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Date
Firstname
Surname
Tel. No. (Home)
Tel. No. (Office)
Postal Address
Post code
Email address




Have you ever been a member
of Lions Clubs International before?

Yes No

If yes, which Club?


How did you hear about Lions Clubs International?

A friend
A relative
An existing member
Leaflet through door
A poster
A Lions event
The TV
The radio
A newspaper
A magazine
Browsing the Internet
Message in a Bottle project


Other (please specify)