International Association of Lions Clubs-Baker City Please complete the form and submit. A club member will contact you within 5 business day. Name Block - Full Title First Name * Last Name * Suffix Address Block - US Address Line 1 Address Line 2 City State Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code Gender Male Female Date of Birth * Spouse's Name I am a: * New Member Former Member Student Member Transfer Member Member Number(If unknown, email stats@lionsclub.org) Previous Club Name Previous Club Number Member Agreement I accept membership into Lions Club International and that the standards are limited to persons of good moral character and reputation. I recognize the importance of rendering personal service to my community in cooperation with other civic-minded persons. I understant that membership is not valid until approved by the club's board of directors. Electronic Signature * Date and Time * Format: M/d/yyyy
