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Scholar's Registration Form
Join the PRIDE of Lions (620 Lions strong) who have received diplomas!
Saturday, June 10, 2017 Sign-in/Breakfast - 7:30 am to 8:20 am University/Reception - 8:20 am to 4:25 pm Collin College Spring Creek Campus - Conference Center
2800 East Spring Creek Parkway, Plano, TX 75074
* Register ON-LINE by going to: www.lions2x1university.org and follow the instructions & pay via PayPal. * Register BY EMAIL, print & complete this form. Scan it and email it to Lion Fred Conger. Pay via PayPal. * Or register BY MAIL, complete this form and mail with registration fee to the address indicated below.
Name: .......................................................... .................................................................... (First Name) (Last Name)
Address: .................................................................................................................................................TX .................................... Street City ZIP Code
Phone: (............)............................ email: .....................................................................@................................................................ Member of Lions Club: ............................................................................... Current Office if any.............................................
Fee: $30.00 if paid by June 9, 2017
$35.00 at the door!
Mail or email Registration Form & Fee to:
GLT Fred Conger, 513 Oakcrest Dr, Coppell, TX 75019-4029
Cell: 214-274-4490 Home: 972-462-1590 email: fredbconger@gmail.com
Fee includes: Course Materials, Breakfast, Lunch, Reception and Diploma (Must be picked up at LU closing) PLEASE SELECT THE APPROPRIATE BOX
Make Checks payable to:
DISTRICT 2-X1
Fee PMaidayby30(s,e2le0c1t3method): Cash $_________
Check # _______ PayPal? Y (circle)
I am a/an: Incoming President Incoming Vice President
Incoming Secretary Incoming Treasurer Incoming Tail Twister Incoming Membership Chair
FBC 04/02/2017
New Club LCIF Chair
New Board Member
New Project Chair
New Lion Club Member
Lion interested in learning new things
Form SRF
VOLUME 27 ISSUE 12 / JUNE 2017
PAGE 5