IOWA LIONS

RALPH A. WHITTEN SERVICE AWARD

9X9 LIONS OF THE YEAR

 

NOMINEE:                Name           ______________________

                                   Address      ______________________

                                                         ______________________

                                   Phone          ______________________

            

                                Club Name  ______________________

                                    District        ______________________

 

NOMINATED BY:    Name            ______________________

                                   Address       ______________________

                                                         ______________________

                                    Phone         ______________________

 

 

SERVICE RECORD OF NOMINEE:           Years a Member  ___________

 

CITE EXAMPLES OF SERVICE TO LIONISM BY NOMINEE:

 

 

 

 

 

 

 

 

 

CITE EXAMPLES OF COMMUNITY SERVICE BY NOMINEE:

 

 

 

 

 

 

 

 

 

USE AS MANY ADDITIONAL SHEETS AS NECESSARY--MUST BE TYPE WRITTEN

RETURN NOMINATION BY JANUARY 15, 2003, TO:

Judy Terry, Vice District Governor

3575 Hanks Drive SE

Iowa City, IA 52240