Application for W.P Woods Fellowship

* Please allow 14 days for processing *

Note: Please click here to inquire on credits before completing application.

"*" indicates required fields

The undersigned Lions Club or Lion in good standing does hereby submit for a W.P. Woods Fellowship;*

The Following is a summary of nominee's contribution to the principles of Lionism:*

Select file to attach for additional nomination information:

Max. file size: 50 MB.

Indiana Lions Foundation is qualified under 501(C)(3) of the Internal Revenue Service code as a public charitable trust.

Nominee Information

Method of Payment

Credits Only

Credit & Cash

Cash Only

W.P. Woods Fellowship Plate with Stand*

$500 or 10 credits

Nominee Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Spouse Name

First Last

Date Desired to Present Fellowship*

Is the recipient a Lion?*

Yes

Is this for Progressive?*

Yes

Applicant Information

Nominee Name as to Appear on Plaque*

First Last

Authorized Person*

First Last

Electronic Signature*

By typing my name above, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid and can be used as my signature.

Address*

Street Address City State ZIP Code

Phone*

Email*

Club Name*

Name of club giving fellowship

District Number*

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Application for W.P Woods Fellowship

Note: Please click here to inquire on credits before completing application.

Nominee Information

Applicant Information

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