Leo Club Membership

Omega Application
As Omega Leo Clubs are designed for young adults ages 18-30, this form is intended to be completed by Leo members who are over
the age of legal majority, up to age 30. Leos who have not yet reached legal age of majority should complete the Alpha Application
for Leo Club Membership (Leo50-A). Because it is the responsibility of the sponsoring Lions club to maintain records on Leo new
member consent, this form should be completed and returned to your Leo club secretary or Leo club advisor who is a member of the
sponsoring Lions club. Completed forms should be kept on file with the sponsoring Lions club and should not be sent to International
Headquarters.

Section I: Applicant information

First (Given) Name Middle Name Last (Family) Name

Street Address City State Postal Code Country

Phone Email

Gender Date of Birth (MM/DD/YY)

I am a: New Member Transfer Member Former Member

Previous Club Name (if applicable) Previous Club Number

How did you hear about the Leo club?

Section II: Applicant Signature

I, the undersigned, am in good standing in my school and/or community, and in accordance with the constitution and bylaws
of this club, hereby apply for membership in the Leo Club, sponsored by the
Lions Club. I believe the above information to be true and complete, and I desire
membership in this club. I believe I can make a contribution to the club and be worthy of the friendship of its members. My
parent(s)/guardian(s) and I understand that the entrance fee will be and the annual
dues will be . I also understand that, pending parental/guardian consent, my
personal data will be entered into Lions Clubs International member databases and used to personalize and improve my membership
experience. To understand how LCI uses your personal data, visit www.lionsclubs.org and search the phrase “Your Privacy”.

Signature Of Applicant Date

Please complete both sides of this form.

Section III: For Leo club secretary or Leo club advisor use only
Copy of completed application added to Leo club’s files Leo added to club roster via MyLCI

APPROVED BY

Leo Club Advisor Signature Date

Section IV: Review and consent

I understand that by participating in this Leo club, I will be required to attend club meetings and club service projects, and may also
be asked to participate in club social events. I also understand that by participating in this Leo club, I may be filmed or photographed
at various club meetings, projects and events. Furthermore, I understand that my personal data will be provided to the sponsoring
Lions club and to Lions Clubs International (LCI) headquarters to facilitate communications with and between our members. This
information is to be used solely to further LCI’s Purposes including “to unite the clubs in bonds of friendship, good fellowship and
mutual understanding” and to conduct its necessary operational activities in accordance with the LCI privacy policy. To understand
how LCI uses the personal data of its members, you may visit www.lionsclubs.org and search the phrase “Your Privacy”.
Please check the appropriate boxes below to indicate the items to which you consent:
I grant permission to be filmed and/or photographed at Leo/Lions events and meetings, and for these videos and/or images to be posted on
the Lions Clubs International public website at www.lionsclubs.org, the Lions Clubs International members-only site (MyLCI), other LCI member
databases, and other Leo/Lion websites at the club, district and multiple district levels.

I grant permission for my personal data to be entered into Lions Clubs International member databases and to be used to facilitate
communications with and between LCI members.

By signing below, you indicate that you have read the information outlined in this form, that you agree to be an active participant
in the Leo club, and that you consent to the items you have checked above. This signed form should be submitted to your Leo club
secretary or Leo club advisor and a copy retained for your own records.

Signature Of Applicant Date

LEO50-O 03/20 EN