OFFICIAL GOVERNOR REQUEST FORM
Club Name: - - Select Your Club - - AGENCY LIONS CLUB AINSWORTH LIONS CLUB ALBIA LIONS CLUB BATAVIA LIONS CLUB BIRMINGHAM LIONS CLUB BLAKESBURG LIONS CLUB BRIGHTON LIONS CLUB BURLINGTON AREA LEO CLUB BURLINGTON NOON LIONS CLUB CENTERVILLE LIONS CLUB COLUMBUS JUNCTION LIONS CLUB CORYDON LIONS CLUB CRAWFORDSVILLE LIONS CLUB DANVILLE LIONS CLUB DONNELLSON LIONS CLUB FAIRFIELD LIONS CLUB FORT MADISON LIONS CLUB FREMONT LIONS CLUB GRANDVIEW-LETTS LIONS CLUB HEDRICK LIONS CLUB IOWA CITY HOST LIONS CLUB IOWA CITY UIHC LIONS CLUB KALONA LIONESS CLUB KEOKUK LIONS CLUB KEOSAUQUA LIONS CLUB KNOXVILLE LIONS CLUB LEIGHTON LIONS CLUB LOCKRIDGE LIONS CLUB LONE TREE LIONS CLUB MARENGO LIONS CLUB MEDIAPOLIS LIONS CLUB MELCHER-DALLAS LIONS CLUB MILTON LIONS CLUB MORNING SUN LIONESS CLUB MORNING SUN LIONS CLUB MOULTON LIONESS CLUB MOULTON LIONS CLUB MOUNT PLEASANT LIONS CLUB NEW LONDON LIONS CLUB NEW SHARON LIONS CLUB OLDS LIONS CLUB OTTUMWA EVENING LIONS CLUB OTTUMWA NOON LIONS CLUB OXFORD LIONS CLUB PACKWOOD LIONS CLUB PELLA LIONS CLUB PLEASANTVILLE LIONESS CLUB PLEASANTVILLE LIONS CLUB RICHLAND LIONS CLUB SIGOURNEY LIONS CLUB STOCKPORT LIONS CLUB VICTOR LIONS CLUB WACO LEO CLUB WASHINGTON LIONS CLUB WAYLAND LIONS CLUB WEST BURLINGTON LIONS CLUB WEST CHESTER LIONS CLUB WHAT CHEER LIONS CLUB WILLIAMSBURG LIONS CLUB WINFIELD LIONS CLUB
Club President:
Club Secretary:
Preferred Date for Visit: (1st Choice) 1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /
Preferred Date for Visit: (2nd Choice) 1 2 3 4 5 6 7 8 9 10 11 12 / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /
Will there be a meal served? Yes No
Is the DG's spouse invited? Yes No
Do you want the DG to induct any new members during the visit? Yes No
Is this a Special event? If so please explain:
Club Contact Name:
Phone Number of Club Contact:
Club Contact Email Address:
Any other miscellaneous comments, information, suggestions, etc?
If there are any awards to be presented by the governor or new members to be inducted, please advise in advance. Have all materials (membership pins, new member packets, etc.) available for these ceremonies.
Please be advised that other LIONS may be traveling with the Governor, i.e. Governor’s wife, Cabinet Secretary, Cabinet Treasurer, Vice District Governor.
The Governor will get back to you as soon as possible to confirm or adjust your request. Thank you for your understanding and cooperation.
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