District Officer Crest Order Form - Lions Clubs International

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Deluxe Lions emblem 5-1/8” diameter. A truly deluxe emblem for use
on blazers and other apparel. When ordering, please specify Official
title, district and years in office. Allow 4 to 6 weeks for delivery.
Each US$22.00
Shipping Information:
Name ____________________________________
Mail Completed Order To:
*Street Address ____________________________
Club Supplies Sales Department
Lions Clubs International
300 W. 22
City ______________________________________
Oak Brook, Illinois 60523-8842
State ___________ Zip Code __________________
Daytime Phone # ___________________________
Or fax order to 630-571-0964
E-Mail ___________________________________
*Please provide a street address for delivery within the US & Canada
Charge To
Club/District/MD Name _________________________
Club/District/MD Account # ______________________
Officer’s Signature _______________________________________
* Club: Club President, Secretary or Treasurer
District: District Governor, Cabinet Sec., Treas. or Sec/Treas
Multiple District: Council Chairperson, Sec., Treas. or Sec/Treas
The protection of your payment data is important to us. Your credit card* purchases of Lions merchandise must be made
directly on line at . Please do not include your credit card number in any written communication or
*Visa, MasterCard, Discover
Crest Quantities & Lettering:
Official Title
District #
Years in Office
A150 03/16


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