Membership Form
Lion International Trading Pin Club Membership Form
Please check the appropriate box or boxes
New:
Renewal:
Change Data:
Name:
Spouse:
Address:
City:
State/Province:
Zip Code
Country:
Res Phone:
Year Joined:
Email:
Sponsor:
Trade by Mail:
Yes
No
Undecided
Lion:
Lioness:
Leo:
CC:
DG:
VDG:
PDG:
PCC:
PID:
ID:
PIP:
MJF:
MD:
Sub-District:
Home Club:
Send LITPC "Trading Post" via email:
Undecided
Yes
No
Dues are $15.00 annually and MUST be paid in U. S. Dollars. You may pay multiple years, if desired. Make check payable to LITPC and send to:
Check Number:
Lion Harry Fulwiler III
Renew for No. Years:
1
2
3
4
5
X Amount (US) $15.00
$15.00
$30.00
$45.00
$60.00
$75.00
LITPC Treasurer
6755 Arthur Hills Drive
Pay by PayPal:
Gainesville, VA 20155-3102
Note: To permit us to mail your quarterly LITPC Newsletter ("Trading Post"), it is extremely important that the address data be in sufficient detail and clarity to permit your postal authority to deliver your mail.