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 Department at least sixty (60) 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 (60) 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.

Speaker request forms received sixty (60) days in advance of the meeting will be confirmed in writing within three (3) weeks of receipt.  Otherwise, confirmation of the meeting will be sent approximately ninety (90) days prior to the event.

You may download the speaker’s picture and biography from our website at www.lionsclubs.org.  If you do not have access to the internet or require the speaker’s flag and anthem, please contact our Public Relations Department at extension #3812 for a Public Relations Kit, free of charge.

In addition, host Lions are encouraged to promote an international officer's visit.

Choice of Speaker and adult companion (required):
Has an invitation been extended directly to the speaker and adult companion ? Yes No
Date of Function: (Month/Day/Year) - -
Type of Function:
District (required):
Function Site:
Accommodations for speaker and adult companion (hotel/motel name etc.)
Nearest Airport:
Miles from airport to accommodations:
Travel time:
Date(s) and time(s) speaker and adult companion are to appear on program:




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:
Business Suit/Dress
Black Jacket
White Jacket
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 adult companion 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

Council Chairman or District Governor:

Business Phone:
Residence Phone:
Cell Phone:
Email Address (required):
Zip/Postal Code:
Please add any additional comments in the box below.

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