Page 15 - Lions Link 10-18
P. 15
2018-2019 Diabetes Awareness Essay Contest District 2-X1 Application Form
“Diabetes in Sports”
Name_________________________DOB____________________M/F____ Address_______________________________________________________
________________________________________________________ E-Mail__________________________Phone ____________________________________ Parent/Guardian Name______________________________________________________ Parent E-Mail___________________________ Phone_____________________________ School Currently Attending_____________________City___________11th/12th grade___ College Plan to Attend_____________________Expected Enrollment Year____________ Sponsoring Lions Club_____________________Club Contact_______________________ Contact E-Mail___________________________Phone____________________________ _______________________ ______________________ ______________________ Signatures: Contestant Parent/Guardian Club President
Return this form, a typed copy of the essay and $100 (payable to 2-X1 Charities) provided by the sponsoring Lions Club to:
Lion Gloria Mathur, 8705 Baltusrol Dr, Flower Mound TX 75022 Gmathur1@tx.rr.com 972-896-9953
Note: These forms can be downloaded from our District 2-X1 website under the resources drop down tab. Look for “District Forms” and under Youth Contest Award select your form to download.
VOLUME 29 ISSUE 4 / OCTOBER 2018 PAGE 16
