Cortland Lions Club

New Member Personal Facts Form

* indicates required field

Residential Address

Vacation Address


Business Address

Please include extensions.


Please enter your children's name, gender, and date of birth.


e.g. Past District Governor (1992/1993), Charter Member (1945/1946), etc.

Provide name of Club and date joined and resigned.

Event Help

Our Picnics, Wedding Receptions, etc., are a major source of income for our club. We are constantly in need of help at these events. To assist us, please check one or more of the following as it pertains to you.

If you've had no experience in the above activities, but are willing to help, please list the activity you would like to help with below.