Speaker Request/Notification Form
Each single, sub and multiple district will be allowed one speaker only each year, approved by Lions Clubs International, for their single, sub or multiple district convention, conference or similar district wide function. The function must be clearly representative of the entire single, sub and multiple district and one to which all clubs are invited to participate. Where the international president, the immediate past president or a vice president is requested as speaker, the function should be representative of the entire single, sub and multiple district and include reasonable schedules with sufficient time to accomplish the purpose of the visit.

The host single, sub and multiple district will be responsible for all local expenses for authorized speakers, including accommodations cost, meals and local transportation. If a district fails to meet this obligation, the district will not be eligible for a speaker in the future until the debt is paid.

This form must be received in the Travel and Administrative Services Department at least sixty days prior to the date of your authorized meeting. Otherwise, the assignment will not be considered official and your speaker’s allowable expenses will not be reimbursed by Lions Clubs International. This sixty-day requirement shall be waived only in the event of an emergency requiring a substitute speaker or in cases where the second vice president or a first year director is requested for an authorized meeting scheduled for July, August or September.
 
Choice of Speaker and spouse (required):
Has an invitation been extended directly to the speaker and spouse? Yes No
Date of Function: (Month/Day/Year) - -
Type of Function:
District (required):
Function Site:
City:
State/Province:
Country:
Accomodations for speaker and spouse (hotel/motel name etc.)
Address:
Phone:
Nearest Airport:
Miles from airport to accommodations:
Travel time:
Date(s) and time(s) speaker and spouse are to appear on program:

Friday:

Saturday:

Sunday:

Desired arrival date and time:
Desired departure date and time:
If unable to attend all scheduled convention activities:
Latest acceptable arrival date and time:
Earliest acceptable departure date and time:
Attire
Friday
Saturday
Sunday
Casual
Business Suit/Dress
Men:
Black Jacket
White Jacket
Women:
Cocktail dress
Full length dress
Approximate number of clubs to be represented:
Estimated attendance at speaker's principle address:
Certified registration at last year's function:
Do you have any particular topics or areas of interest you would like the speaker to address in a general session?
Do you have any particular topics or areas of interest you would like the spouse to address in a general session?
Please provide a name and phone number for an emergency contact other than the District Governor during the day of arrival of your International Guest
Name:
Phone:

Council Chairman or District Governor:
Business Phone:
Residence Phone:
Cell Phone:
Fax:
Email Address (required):
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Please add any additional comments in the box below.