LIONS CLUBS INTERNATIONAL District 301-A2 PHILIPPINES

FIRST GOVERNOR’S VISITATION FORM

LION YEAR 2021 - 2022
Club Name: Club Number:
RegiON: ZoNE:
CLUB OFFICERS FOR LY 2020-21
POSITION NAME EMAIL ADDRESS & MOBILE NO.
President
1st Vice Pres.
2nd Vice Pres.
Secretary
Treasurer
Tamer
Tail Twister
Membership
Service
LCIF
Marketing &
Communication
PAYMENT OF DUES
First Semester Payments – July 1 to December 31, 2021 DEADLINE: JULY 10, 2021
No. of Amount Date
TYPE OF DUES Members Paid Paid
International Due 21.50/member
District Due P250/ member
TOTAL AMOUNT PAID
Second Semester Payments – January 1 to June 30, 2022 DEADLINE: JAN. 10, 2022
No. of Amount Date
TYPE OF DUES Members Paid Paid
International Due 21.50/member
District Due P250/ member
TOTAL AMOUNT PAID

CLUB CONSTITUTION & BY-LAWS : Mandatory to follow the July 1, 2016 (New)
Revised : YES ( ) NO ( )
Copy Submitted to District : YES ( ) DATE: ________________ NO ( )

MONTHLY MEMBERSHIP REPORT (MMR) Submission Deadline: Every 20th of each month.
MMR for the month of July submitted: YES ( ) DATE: ____________ NO ( )
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 MONTHLY ACTIVITY REPORT (MAR) Submission Deadline: Every 20th of each month.
MAR for the month of July submitted: YES ( ) DATE: _________________ NO ( )

MEMBERSHIP
SUMMARY OF As of As of This
MEMBERSHIP 6/30/2021 Reporting
Total No. Membership
New Members Recruited
Members Dropped
NET GAIN / - LOSS

TARGET TARGET
MONTH NEW MEMBERS NEW
CLUB
2021
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
2021
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
TOTALS

SERVICE ACTIVITIES For the Month of July, 2021

Please attached 1 Photo of each Service Activity as Addendum to this page.
TYPE OF SERVICE No. of People Served /
ACTIVITY (IES) DETAILS No. of Lions Attended
Hunger
Diabetes
Vision
Environment
Childhood Cancer
Youth
Administrative:

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 LEADERSHIP DEVELOPMENT
Names of Club Officers who attended
PSTM & RC/ZC Leadership Training Seminars:
POSITION FULL NAME .. Pls indicate if MJF or PMJF
President
1st Vice President
2nd Vice President
Secretary
Treasurer
Membership
Others: LCIF Coordinator
Region Chairperson
Zone Chairperson
District Officer(s)
DG
IPDG
District LCIF Coordinator
SFK Reg’l Coordinator

DONATIONS TO LCIF
Names of Club Officers & Members who have donated to LCIF:
(Please indicate if MJF, PMJF, 2PMJF or under Campaign 100)
POSITION FULL NAME / MJF or PMJF or $100 Donation
IPDG
DG
CABSEC

MEMBER

Is your Club MJF or PMJF? No If Yes, pls indicate Date When : ________________
If your Club is not yet MJF, do you intend to make it MJF? ______ If Yes, When Date? ______________

LEO CLUB As of July 1, 2021

NAME OF LEO CLUB:____________
Date Organized: _______________
Total No. of Members: __________

LEO OFFICERS FOR LION YEAR 2021 - 2022

FULL NAMES
POSITIONS OF OFFICERS

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 PLANS & PROGRAMS FOR LION YEAR 2021-2022
NOTE: Each Club must have at least 1 Flagship Project & Legacy Project preferably of all 3 Levels
as presented in the DG Goals together with the 5 Global Causes: Hunger, Diabetes, Vision,
Environment and Childhood Cancer. If the Club has existing Leo Club, they must be involved in
the conduct of Service Activities and can be reported under Youth. Also include Creating Public
Awareness Projects.

SERVICE TARGET NO. OF

MONTH ACTIVITY DETAILS OF SERVICE ACTIVITY PEOPLE TO BE
CATEGORY SERVED

YOUR CLUB’S INDUCTION

Date: ________________________

I hereby certify that all information contained in four (4) pages of this report is true and correct
to the best of my knowledge.

Submitted by: Approved by:

Club Secretary Club President

(Signature Above Printed Name) (Signature Above Printed Name)

Date Submitted:

______________