Club Name:
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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.