IOWA LIONS
RALPH A. WHITTEN SERVICE AWARD
9___ LIONS OF THE YEAR

NOMINEE:

Name: ______________________________________

Address: ___________________________________
_______________________________________________

Phone: ______________________

Club Name: ________________________________

NOMINATED BY:

Name: ______________________________________

Address: ___________________________________
_______________________________________________

Phone: ______________________

SERVICE RECORD OF NOMINEE:

Years a Member: ___________

CITE EXAMPLES OF SERVICE TO LIONISM BY NOMINEE:
 
 
 
 
 
 
 

CITE EXAMPLES OF COMMUNITY SERVICE BY NOMINEE:
 
 
 
 
 
 
 

USE AS MANY ADDITIONAL SHEETS AS NECESSARY--MUST BE TYPE WRITTEN

RETURN NOMINATION TO: