Yes! I want to become a Poulsbo Lion

Please complete all parts of the form.

If a current member asked you to join, what was their name?
Title (Dr, Judge, Sir, etc.):
* First name:
Middle Initial:
Nickname:
* Last name:
Suffix (Jr, Sr, III, etc.):
* Gender:	Female Male Non-Binary Prefer not to answer
* Date of Birth (required to determine dues) (MM/DD/YYYY):
Spouse First name (or nickname if preferred):
Spouse Last name (if different):
* Address:
* City:
* State:
* Zip:	—
* Phone Type:	Cell Home Work
* Phone:	Format: 123-456-7890
* Email:
* I am applying for the following member type:	New Member Former Member Transfer Member Family Member Student Member LEO to Lion Member Young Adult Member	If you are a Transfer or Former Member: Member Number: Previous Club Name: Previous Club Number:
* There are two groups of Poulsbo Lions. The major difference is when they meet. The main club meets at noon every Thursday The evening branch meets at 7 PM the 1st and 3rd Thursday	I would prefer to join: Noon Club Evening Branch

* I acknowlege that the information provided is correct.
* I understand that membership is by invitation and must be approved by the Poulsbo Lions Club Board of Directors.
* I understand that Lions Club members are persons of good moral character and reputation and that membership may be revoked for any reason or no reason by a majority vote of the Club Board of Directors.