District 2-S3 Texas Forum Scholarship Application

District 2-S3 Texas Forum Scholarship Application. Applicant Name: Date of Application: ______ ... Mobile Phone: ______ Email: Club Name: Club Location: ...
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District 2-S3 Texas Forum Scholarship Application Applicant Name: _____________________________________________ Date of Application: ________ Current Address: ______________________________ City: ______________ State: ___ Zip: _________ Home Phone: ________________ Mobile Phone: _____________ Email: __________________________ Club Name: __________________ Club Location: ____________________ Year Joined _____________ Highest Office held in Lions: ___________________________________ Year Held: ________________ Club where you held it _____________________________________ Do you aspire to hold any of the following positions? Circle all that apply Zone Chair, Region Chair, Guiding Lion, 2nd Vice District Governor, Elected Director TLC, Elected Director Lonestar Lions Eye Bank, Cabinet Secretary, Cabinet Treasurer What presentations on the Texas Forum registration form to be presented interests you the most? and Why? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Applicant’s Signature: ________________________________ Date: ______________________ Club Secretary Signature: _________________________________ Date: __________________

Please Send Your completed application to: PDG Michael Smith 604 S Seguin Ave New Braunfels, Tx 78130 Or by Email: [email protected] Deadline for Application is November 1, 2017