Lions Club International Registration Form

Lions
- Title
- Surname
- Given Names
Partner
- Title
- Surname
- Given Names
Lioness
- Title
- Surname
- Given Names
Leo
- Title
- Surname
- Given Names
Guest
- Title
- Surname
- Given Names
- CLUB
- DISTRICT
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Phone
- Mobile
Email
Is this your first Convention?
- Yes
- No
We are staying at
- Special Dietary requirements
- Special Needs
MEALS AND FUNCTIONS – Choose individually please
- Date
- Day
- Function
- Time
- Cost PP
- Number
- Total
- 25/10/2019
- Friday
- Welcome BBQ - Free
- 4.00pm–6.00pm
- Free
- Number
- Total
- 25/10/2019
- Friday
- Informal Reception Drinks at Bar Prices
- 7.00pm - 9.00pm
- $15.00
- Number
- Total
- 26/10/2019
- Saturday
- Breakfast at the school
- 7.00am –8.00am
- $15.00
- Number
- Total
- 26/10/2019
- Saturday
- Lunch at the school
- Approx. 12.30pm
- $15.00
- Number
- Total
- 26/10/2019
- Saturday
- Dinner Dance-Safety Beach Sailing Club
- 7.00pm–11.00pm
- $40.00
- Number
- Total
- 27/10/2019
- Sunday
- Breakfast at the school
- 7.00am – 8.00am
- $15.00
- Number
- Total
- 27/10/2019
- Sunday
- Lunch at the school
- Approx. 12.30pm
- $15.00
- Number
- Total
- Convention Pins
- $7.00
- Number
- Total
- TOTAL:
- Number Total
- Grand Total
- Personal Cheque
- Money Order
- EFT
- Amount

MEALS AND FUNCTIONS – Choose individually please