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Lions Clubs International - District 2-X1, 2017-18
District Governor Henry White
Grassroots Lion Award
Nomination Form
Deadline for submission: April 1, 2018
Club Name: .............................................................................. Club contact person ................................. Contact person’s Phone: ...................................................,...... email: ............................................................
Grassroots Lion - Must be a Lion of 5 years or less - One Lion from a Club Name: .............................................................................................. .............................................................................
(first name) (last name) Partner-in-service: ...............................................................................................................................................................
Children Name(s) ........................................................................ ............................................................................. ........................................................................ .............................................................................
This Grassroots Lion ........................................................ became a Lion in .................... He/She is worthy of this prestigious
recognition because ...... (a maximum of first 100 words only will appear in the Program Booklet) ...................... .............................................................................................................................................................................................................
............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ............................................................................................................................................................................................................. ..........................................................................................................................................................................................................
Please mail this completed Nomination Form with $10 fee to: Check payable to “District 2-X1” with memo “Grassroots Lion Fee”
2VDG Vinod Mathur 8705 Baltusrol Dr. Flower Mound, TX 75022
vrmathur@tx.rr.com 817-705-4096
Grassroots Dinner Reservation for the Award Nominee and others must be made in ADVANCE and paid separately using the ‘District Convention Registration Form’. Grassroots Banquet is on Saturday April 28, 2018
NOTE: These forms can be downloaded from our District 2-X1 website under the resources drop down tab. Look for “District Forms” and under Grassroots Nomination Forms to select for download.
VOLUME 28 ISSUE 9 / MARCH 2018 PAGE 10