TRANSFER MEMBER FORM
lnstructions for Lions Club Secretary
1. Complete this form. (A dropped member must join a Lions club within six months to
maintain continuous membership.)
2. Forward three copies to Lions Clubs International for processing.
3. Retain one copy for your club files.
TO: NAME OF NEWLIONS CLUB (if known) _______________________________________District___________
New Lions Club Account Number __________________ (Found in directory)
We are pleased to recommend thls Lion In good standing for membershlp in your club.
Full Name: ____________________________________Spouse‘s Name__________________________________
New Address: _________________________________________________________________________________
Telephone: ____________________________________Arrival date in your area: ___________________________
A Lion since: Listed as a dropped member on our M&A Report for the month of:_______________
Highest Chevron received: _______________________________________________________________________
Highest Membership Key awarded: ________________________________________________________________
Sponsored the following new members who will count as credit toward Key Awards on dates shown
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Member a Melvin Jones FeIlow? Yes__________ No___________
Highest club office held: ___________________________________________
Highest district office held: _________________________________________
Highest multiple district office held: ___________________________________
Highest international office held: _____________________________________
Special remarks: _______________________________________________________________________________
Member‘s club service record available on request Yes__________ No___________
Former Club Name: ______________________________________ Former Club Account Number _______________________________
Address: ____________________________ ____________________ District________________________________
______________________________________________________________________________________________________________________________ Secretary‘s telephone_________________
Date _______________ ________________________________________________________________
Former Club Secretary‘s Signature
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
NEW CLUB SECRETARY: Please complete this page and return to Llons Clubs International.
Lion ________________________________________a former member of ________________________
District ______________was accepted as a transfer in our Lions Club of ___________________________________
_________________________________________________________________________________________District ____________________________on ____________________________________________________
Date ________________ ______________________ ____________________________________________________________________________________________________________________
New Club Secretary‘s Signature