5M9 District Governor ~ Cathe Picek ~ Club Visit Form 
To request a visit from the District Governor, please fill out the following form. Cathe will cover Zones 1,2, and 3. Sheri will cover Zones 4,5, and 7. Diane will cover Zones 6 and 8.

Gifts are not necessary, but are always welcomed and appreciated. 

Cathe Picek:  cathe.picek@gmail.com,   218-330-7804
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Email *
Name of Lion submitting this form and best contact *
Club Name *
Club Location *
Club Meeting Address (if this is a business, please provide the name) and any relevant details such as cross streets, room or suite numbers, etc. *
First Choice Date for Club visit *
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Second Choice Date for Club visit *
MM
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DD
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YYYY
Third Choice Date for Club visit
MM
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DD
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YYYY
Would you like the DG or VDG to attend? *
Dress code requested *
What time is Social Hour?
Time
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What time is Meal time?
Time
:
What time does the club meeting begin? *
Time
:
Is this a Board meeting? *
If yes, do you request the DG team to attend?
Clear selection
Are there other Lions or Leos Clubs involved in this visit? *
If yes, please list:
Will the DG be expected to install Officers? *
If yes, please list names and positions of new officers:
Will the DG be expected to induct new members? *
If yes, please have LI New Member kit for IP  A.P. Singh. Please list new member name(s) and their sponsor(s) so we can prepare certificates.
Will the DG be expected to give out awards to Club members? *
If yes, please give information stating the awards and names of those receiving. Please have awards, certificates, pins, or changes in installation or inductee ceremony available when we arrive for the DG visit.
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