Leo District Council

District 315 B3, Bangladesh

Lions Clubs International

Membership Form
(2023-2024)
Date : Date

Club Information
(*) Your information must be mentioned
* Leo Club Name : Leo Club Name
* Sponsoring Lions Club Name : Lions Club Name
* Leo Club ID : Leo Club ID * Lions Club ID : Lions Club ID
* Member ID : Member ID * Club Designation : Club Designation

Personal Information

* Name : Name
Father’s Name : Father’s Name.
Mother’s Name : Mother’s Name
Town/Road/House/Flat District
* Address :
P.S./Upazila Post Office Post Code
* Mobile : Phone * Date of Birth : Date of Birth
* Gender: Gender Marital Status : Status * Religion : Choose an.
* Blood Group : Groups Professions : Professions
Be mentally prepared to donate blood for special
needs
Academic Qualification : Educational Degree
* E-mail : E-mail
Hobbies : In Word

I hereby declare that the above information is correct.

Member Signature Signature Size 300×80 pixels Club Secretary Signature

Lead The Change