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Lions Clubs International – District 2-X1 District Governor Keith Murray Grassroots Lion Award 2018-2019
Nomination Form
Deadline for Submission April 1, 2019
Must be a Lion for 5 Years or Less – One per Club
Club Name: _________________________Club Contact________________________ Phone: ________________ EMAIL: _____________________________
Name of Grass Roots Lion: _____________________________________
Partner in Service: ____________________________________________
Lion _____________________ became a Lion in ____________________
This Lion is worthy of recognition as a Grass Roots Lion because:
Maximum of 100 words will appear in the program (can submit this in document format):
__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________
Please attach $10.00 Fee to: Check payable to “District 2-X1”
Submit completed form to District 2-X1 Second Vice District Governor Billy Ketner by the April 1, 2019 deadline at:
Lion Billy Ketner
4723 Jackson Meadows Dr. Sachse, TX 75048
bket47@gmail.com
972-414-9922
(On Line submission preferred)
Grassroots banquet will be held on Saturday April 27, during District Convention.
VOLUME 29 ISSUE 10 / APRIL 2019
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