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Leo Club Officers and Membership Report Form

For the fiscal year beginning July 1, use this form to report your newly-elected Leo club officers to the Youth Programs Department at Lions Clubs International Headquarters by May 15. If you are a school-based club and do not hold officer elections until the new school year, it is acceptable to submit this form by September 30. All communications directed to the club officers throughout the year will be based on the information provided in this form.

This electronic form will be sent to the Lions Clubs International Office. It is your responsibility to print and send this information to the District Leo chairperson and to your sponsoring Lions club.

* Indicates required fields.

*Leo Club Name:

*Total number of members:

*Sponsoring Lions Club Name:

* Please provide a current membership list in the box below:

*Each Leo club must declare itself as an Alpha Leo Club (12-18 years of age) or an Omega Leo Club (18-30 years of age). Please select one of the following:

ALPHA

OMEGA

*Each Leo club must declare itself as a community-based or school-based club. Please select one of the following:

COMMUNITY-BASED

SCHOOL-BASED

*Lions District Number:

*Lions Club Six Digit Identification Number:

Leo Club Advisor (60)

*First Name:

Middle Initial:

*Last Name:

*Lions Member ID Number:

*Street Address or P.O. Box Number:

*City:

*State or Province:

*Country:

*Postal Code:

*Telephone Number:

Fax Number:

**E-mail:
*A unique e-mail address is required to use the online membership reporting system.

Leo Club President (61)

*First Name:

Middle Initial:

*Last Name:

*Street Address or P.O. Box Number:

*City:

*State or Province:

*Country:

*Postal Code:

*Telephone Number:

Fax Number:

**E-mail:
*A unique e-mail address is required to use the online membership reporting system.

Leo Club Secretary

First Name:

Middle Initial:

Last Name:

Street Address or P.O. Box Number:

City:

State or Province:

Country:

Postal Code:

Telephone Number:

Fax Number:

*E-mail:
*A unique e-mail address is required to use the online membership reporting system.

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