Clear Lake Lions
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Individual Request Form
Organization Request Form
Member
Individual Funds Request
Please follow the steps below to request funds for an individual
Fill out this form as much as possible.
Click the
SUBMIT
button on the bottom of this page.
After reviewing your request, we may contact you to attend one of our meetings and present your request to our club.
Requests received after the Friday before our Tuesday meeting
(see calendar for meeting dates)
may not make it on the current agenda.
Request may take up to 90 days for a response.
*
Indicates required field
Request For
*
First
Last
For whom are you requesting assistance?
Reason For Request
*
Why are you requesting assistance?
Amount Requested
*
How much are you requesting?
Asking Others
*
Yes, We are asking others
No, we are not asking others
Are you requesting assistance form other organizations?
Contact Name
*
First
Last
The name of the person making the request
Contact Phone Number
*
Please enter the phone number of the person to contact regarding this request.
Contact Email
*
The email address of the person making the request.
Submit my Request