Leo To Lion Certification Form Page 2
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1
2SECTION III. CH RTER/ENTR NCE FEE W IVER
In order to receive the charter/entrance fee waiver and/or international dues discount, you must have
requested your Leo Completion of Service Certificate. Please check one of the following:
I
I have completed section I to request my certificate.
I
I have already received my certificate.
Please select the appropriate option:
I
Leo Lion (Former Leo Through ge 30)
A Leo Lion is a current or former member of a Leo club, between the age of legal majority and through
age 30, joining any type of Lions club. Leo Lions are eligible to receive a charter/entrance fee waiver and
pay only half international dues if they have been a Leo for at least a year and a day, through age 30, and
can transfer their Leo years of service to their Lions’ membership record upon completion of this form.
Verify Age:
I
I
I
I
I
DR - Drivers License
SC - State ID Card
BC - Birth Certificate
PP – Passport
OT – Other
I
Qualifying Young dult
Young adults, through age 30, joining a Leo Lions club formed by 10 or more Leo Lions who have been a
Leo for at least a year and a day, are eligible to receive a charter/entrance fee waiver and pay only half
international dues, through age 30, upon completion of this form.
Verify Age:
I
I
I
I
I
DR - Drivers License
SC - State ID Card
BC - Birth Certificate
PP – Passport
OT – Other
I
Former Leo Over ge 30
All former members of a Leo club are eligible to receive a charter/entrance fee waiver credit for their Leo
years of service when joining any type of Lions club and upon completion of this form. Regular
international dues apply.
Leo to Lions Club Program International Dues Structure
Charter Fee
Entrance Fee
International Dues
Leo Lion
US$0
US$0
US$21.50
Qualifying Young Adult
US$0
US$0
US$21.50
Former Leo Over Age 30
US$0
US$0
US$43
District Governor, Guiding Lion or Lions Club Secretary
y signing this form, I certify that I am the current district governor, guiding Lion or club secretary and have verified
the above member is a former Leo or qualifying young adult.
Print Name: ___________________________________________________ Lions Title: ____________________________
Signature: _____________________________________________________ Date: _________________________________
General questions about the Leo to Lion transition may be directed to the .
Former Leos chartering a new Lions club -
Requests for Leo Completion of Service Certificates,
submit this form along with charter paperwork to:
credit for Leo years of service and former Leos join-
ing existing Lions clubs – submit this form to:
Membership and New Club Operations Department
Lions Clubs International
Youth Programs Department
300 W. 22nd Street Oak Brook, IL 60523 USA
Lions Clubs International
Phone: 630.203.3831
300 W. 22nd Street Oak Brook, IL 60523 USA
Fax: 630.571.1691
Phone: 630.571.5466
Email:
Fax: 630.571.1692
Email:
LL-2 7/13 EN
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