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ANZI New Club Development Workshops

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Print New Club Development Request Form

To request a new club development workshop, please complete a request form (pdf) or complete the below form:

* Required

*District:

*Month to hold training:

*Workshop location:

*Prospective Community #1:

*Type of club to form:

*Proximity to the workshop location:

km/miles

Prospective Community #2:

Type of club to form:

Proximity to the workshop location:

km/miles

*Estimated number of participants:

Requested Consultant**:

** I understand that it is not guaranteed that he or she will be able to facilitate the workshop

Additional comments on the workshop, prospective communities and/or recruiting methods:

*Name:

*Lion Title:

*Phone Number:

*Email:

*Cell/Mobile Number:

If you have a P.O. Box, please provide a street mailing address that LCI can ship materials by courier to

*Shipping Address:

*City:

State/Province:

Zip/Postal Code:

*Country:

If your district governor does not have an email address, please enter in the district secretary's email

*District Governor Name:

*District Governor Email:

Use club organizer information above?

Yes No

If you are a district governor, check here

*Name:

*Lions Title:

*Phone:

*Email:

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