Regional Lions Leadership Institute Application
Please complete the application.  Upon acceptance for the upcoming Institute, a tentative agenda and information regarding payment will be sent to you by MD13 GLT Coordinator, PDG Jackie Miller.  All applications must be received no later than September 24, 2021.  Any questions please contact PDG Jackie at pdgjackie@gmail.com.  THANK YOU for your interest in the Regional Lions Leadership Institute!

By completing this application you agreeing to attend the Institute!  This is on a first come first serve basis and once all 25 spots have been filled no one else will be accepted.  Therefore, please make certain you can attend before signing up.  We will notify you of your acceptance, once we know we have enough Lions registered to attend.
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Desired course level: *
Lions Name (First and Last) *
Street Address *
City *
State *
Email *
Mobile Phone Number (List Home # if no mobile phone) *
District *
Club *
Club Number (If unknown, check your membership information on LCI's site) *
Lions Membership Number *
Year you joined Lions *
List Leadership roles you've held in our Club/District *
List Leadership roles you've held in your community *
Why are you applying for this institute? *
Where do you see yourself in Lions in five (5) years? *
If accepted, will you be able to attend all sessions from Saturday, November 13 thru Sunday November 14, 2021? *
Any additional information you would like to provide or any additional questions you may have?  On behalf of the GLT Committee, THANK YOU for your interest in RLLI!
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