Application for W.P Woods Fellowship

Please allow 14 days for processing

Note: Please click here to inquire on credits before completing application.

The undersigned Lions Club or Lion in good standing does hereby submit the name of for a W.P Woods Fellowship.

The following is a summary of nominee's contribution to the principles of Lionism:

Select file to attach for additional nomination information (optional):


Indiana Lions Foundation is qualified under 501(C)(3) of the Internal Revenue Service code as a public charitable trust.


 
Click here if using W.P Woods credits or cash on account
W.P Woods Fellowship Plate with Stand:  ($500 or 10 credits)
Cash amount towards plaque: $
Individual Name:
Address:
City:
State:
Zip:
Phone:
Name of Spouse:
Date Desired to Present Fellowship:
November 19 2019
Click here if the recipient is a Lion
Click here if this is for Progressive







 
Applicant:
Authorized Officer:
By typing my name below, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid and can be used as my signature.
Electronic Signature:
Address:
City:
State:
Zip:
Phone:
Club Name: (name of club giving fellowship)
District Number: