Lions District 306 D12 Convention Registration

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INSTRUCTIONS

Membership Identification

UPLOAD YOUR PHOTO *

MEMBERSHIP No *

NAME OF LION*

LIONS CLUB OF*

REGION*

ZONE*

Contact

MOBILE PHONE No*

E-MAIL*

OFFICE PHONE No

WHATSAPP PHONE No*

Dependents

SPOUSE NAME

GUEST(S) NAMES

LEO(S) NAMES

Convention Fees

DESCRIPTION	AMOUNT (RS.)	QUANTITY
REGISTRATION - LION	2500	1 (Fixed)
REGISTRATION - SPOUSE	1000
REGISTRATION - GUEST	2000
REGISTRATION - LEO	1000
CONVENTION - PIN	500
CONVENTION - BANQUET	5000
SNACKS & TEA (Day 1)	500
SNACKS & TEA (Day 2)	500
CONVENTION - SOUVENIR	500

Payment Details

NAME OF THE BANK:*

CHEQUE / REF No:*

BRANCH:*

TOTAL AMOUNT TO PAY (RS.)