Leo October Membership Growth Award Nomination Form

The Leo October Membership Growth Award may be presented to any Leo who recruits three or more new
members during the month of October to the Leo club in which he/she is a member. To obtain this certificate,
Leo club advisors must submit this form by the November 15 deadline.

IMPORTANT NOTES

• The newly recruited Leo club members must be added to the Leo club roster in MyLCI in the month of
October.
• Completed forms will only be accepted by the reported Leo club advisor or an officer of the sponsoring
Lions club.
• The email address provided must be that of the Leo club advisor as it will be used to deliver the
certificate.

RECIPIENT
Rohit Dujari 5694835
Leo Member Name: ________________________ Leo Member ID:_______________________

Leo Club Name:

Nagpur Central Elite Leo Club Number:
148340
Number of New Leo Members Recruited:
3
Gaurang Sudhir Chourasia 5711309
New Leo club member name:________________________________Member ID:_____________________________
Nikhil Ravindra Rathi 5711322
New Leo club member name:________________________________Member ID:_____________________________
Akhil Narendra Vaidya 5711333
New Leo club member name:________________________________Member ID:_____________________________

New Leo club member name:________________________________Member ID:_____________________________

New Leo club member name:________________________________Member ID:_____________________________

ADDITIONALS CAN BE ADDED ON REVERSE SIDE

NOMINATOR

Sponsoring Lions Club:

NAGPUR CENTRAL District:
3234H1
Current Leo Club Advisor:
Rajesh Chandak Member ID:
3239980
E-mail:
lionrajchandak@gmail.com
Signature: Date:

Please submit completed forms using one of the below methods.

Email: leo@lionsclubs.org
Lions Clubs International, Leo Club Program | 300 W. 22nd Street, Oak Brook, Illinois 60523-8842, USA

Leo-101.EN 7/2019