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Leo 72

This document provides instructions for Leo club officers to report club officer information for the 2016-2017 fiscal year beginning July 1, 2016. It outlines how to submit the officer information via an online system or via a paper form. It requests information about the Leo club such as the name, ID number, type of club (Alpha/Omega, school-based/community-based), and contact information for the Leo club advisor and president. It also requires a signature from the sponsoring Lions club to confirm parental consent forms are on file for club members. The deadline to submit is May 1, but September 30 for school-based clubs that elect officers later.

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Jessie Kong
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247 views

Leo 72

This document provides instructions for Leo club officers to report club officer information for the 2016-2017 fiscal year beginning July 1, 2016. It outlines how to submit the officer information via an online system or via a paper form. It requests information about the Leo club such as the name, ID number, type of club (Alpha/Omega, school-based/community-based), and contact information for the Leo club advisor and president. It also requires a signature from the sponsoring Lions club to confirm parental consent forms are on file for club members. The deadline to submit is May 1, but September 30 for school-based clubs that elect officers later.

Uploaded by

Jessie Kong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LEO CLUB OFFICERS REPORT

For fiscal year beginning July 1, 2016


Leo club officers can be reported via MyLCI. For assistance, review the step-by-step instructions. If you are unable to report
via MyLCI, you may submit this form to the Leo Club Program Department at Lions Clubs International Headquarters by May
1. This form must be completed by the sponsoring Lions club president, sponsoring Lions club secretary or Leo club advisor
who is a member of the sponsoring Lions club. Please type or print clearly. MyLCI login registration requirements for
officers are based on the information provided on this form. If you are a school-based club and do not hold officer elections
until later in the year, please submit this form by September 30.
Leo Club Name _

Leo Club ID Number

Sponsoring Lions Club Name


Lions Club ID Number _________________

Lions District _____________

Lions Multiple District

1.) Each Leo club must declare itself an Alpha Leo Club (12 to 18 years of age) or an Omega Leo Club (18 to 30 years of
age). Alphas and Omegas should not be members within the same Leo club.
Select only one:

This club is an

Alpha Leo Club (12-18 yrs.)

OR

Omega Leo Club (18-30 yrs.)

2.) Each Leo club must also declare itself a school-based or a community-based Leo club. Both Alpha and Omega clubs
can be based at a school or in the community.
Select only one:

This club is a

School-based Club

OR

Community-based Club

SECTION I: LEO CLUB ADVISOR INFORMATION


Leo Club Advisor (must be a member of the sponsoring Lions club; receives all communication from LCI)
First (Given) Name _____________________________________________ Last (Family) Name __________________________________________________
Lions Member ID Number ___________________________ Street Address __________________________________________________________________
City _______________________________State _______________________ Postal Code___________________ Country _____________________________
Preferred Phone ____________________________________________*Email ________________________________________________________________
*A unique email address is required to use the MyLCI online reporting system.

Leo Club Co-Advisor or Faculty Advisor


First (Given) Name _____________________________________________ Last (Family) Name __________________________________________________
*Email _______________________________________________________ *Faculty advisor will not have access to the MyLCI online reporting system.

Leo-72.EN 01/16

Please complete both sides of this form

SECTION II: LEO CLUB PRESIDENT INFORMATION


First (Given) Name _____________________________________________ Last (Family) Name __________________________________________________
Leo ID Number_____________________________________ Street Address _________________________________________________________________
City _________________________________ State __________________ Postal Code__________________ Country ________________________________
Preferred Phone ____________________________________________ *Email _______________________________________________________________

Year of Birth _____________

*A unique email address is required to use the MyLCI online reporting system.

SECTION III: PARENTAL/GUARDIAN OR MEMBER CONSENT

It is the responsibility of the sponsoring Lions club to maintain records of consent for any young person who joins your Leo
club. The Alpha Application for Leo Club Membership (Leo50-A) should be reviewed and completed by the parent or guardian
of Leo club members under the legal age of majority and kept on file by the sponsoring Lions club. The Omega Application for
Leo Club Membership (Leo50-O) should be reviewed and completed by new Leo club members over the age of legal majority
and kept on file by the sponsoring Lions club.
By signing below, I confirm that a completed Application for Leo Club Membership (Leo50-A or Leo50-O) has been received
for all Leo club officers and members, including the Leo club president listed above. The completed Leo50 form indicates
consent for the Leos personal data to be entered into LCI member databases to be used to facilitate communications with
and between members. I understand the personal information provided is to be used solely to further LCIs Purposes
including to unite the clubs in bonds of friendship, good fellowship and mutual understanding and to conduct its
necessary operational activities in accordance with the LCI privacy policy.

__________________________________
Signature of Lions club president,
Lions club secretary or Leo club advisor

______________________________
Name of signee/officer

_____________________________
Title

______________________________
Lions Member ID Number

_____________________________
Date

********************************************************************************************************************
Please submit completed form using one of the below methods:
Email: [email protected]
Fax: +1 630 571 1692
Lions Clubs International, Leo Club Program Department | 300 W. 22nd Street, Oak Brook, Illinois 60523-8842, USA

Leo-72.EN 01/16

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