Name of Club:____________________________________________________________

Month:_______________________

Activities/Projects: (use reverse of additional space is required)

Number of Members: Beginning of Month__________ End of Month__________

President:__________________________ Secretary:_____________________________

Address____________________________ Address______________________________

________________________________________________________________________

Telephone _________________________ Telephone_____________________________

e-mail _____________________________ e-mail _______________________________

(A copy of this report should be mailed to each of the following by the 2nd of each month: District Governor, Vice District Governor, District Leo Coordinator, Region Chairperson, Zone Chairperson, Sponsoring Lions Club, District Newsletter)