Application for Membership

Name: _____________________________________________

Address: ___________________________________________

___________________________________________

Phone Number:

Home: ( )_________-____________

Cell: ( )_-____

Work: ( )_________-____________

Date of Birth: _//____

Sponsor’s name: ______________________________

For informational purposes only:

What other organizations do you take part in? How long?
_____________________________________________________________

_____________________________________________________________

Why did you decide to join the Park-Port Lioness Club?

_____________________________________________________________

Signature: ______________ Date: _

For more information contact Lioness Jennifer Schottmuller at 612-419-3512 or by email, at 1vp@parkportlioness.org
Your application can be turned in at a meeting or sent in to PO Box 65 St. Paul Park, MN 55071.

Name: _____________________________________________

Cell: ( )_________-____________

Date of Birth: _____/______/______

Signature: __________________________ Date: _____________

Cell: ( )_-____

Date of Birth: _//____

Signature: ______________ Date: _