Cumulative Melvin Jones Fellowship (MJF) Credits Application

Please note – This form should only be used if sufficient funds have been previously donated to Lions Clubs International Foundation and you have confirmed the credits are available in the multiple district/district or club's LCIF account before submitting this application. To confirm available credits, please contact Donor Assistance via email at DonorAssistance@lionsclubs.org or 630-203-3836.

If you need to submit an application with a new donation, please refer to other Ways to Give or donate and request recognition by credit card.

Fellowship

MJF credits to be used from:

Club/District/Multiple District/Individual Name

Club Number

Full Name of Person Completing Form

Country Code

Phone Number

Email

Name as it should appear on plaque (MJF) - Recipient Name (PMJF)

Note: 32 character space limit; Recipient must be an individual person, not a club or corporation.

Member ID

If non-Lion please enter 11111

Is the recipient deceased?

If recipient is deceased, please provide family name.

Recognition items cannot be sent to a P.O. Box

Member ID

Name

First NameLast Name

Address

Address 2

Address 3

City

State/Province

Zip/Postal Code

Country

Country Code

Phone Number

Email

A Tax ID# is necessary in various countries for compliance purposes. Examples include India’s Know Your Customer (KYC), Brazil’s Cadastro de Pessoas Físicas (CPF), Bangladesh’s National Identity Card (NID) and Korea’s Residential ID. If required, please identify your Tax ID#. Note: Many countries may charge custom and VAT fees for importation of Melvin Jones Fellowship plaques and other LCIF recognition. These fees are the responsibility of the individual, club or district receiving the plaques.

Special Instructions

Per Lions Clubs International Foundation's (LCIF’s) standard operating procedures, customs duties, and VAT charges on the importation of Melvin Jones Fellowship (MJF) plaques and other recognition items are the responsibility of the shipping recipient. LCIF makes every effort to ensure the customs invoices submitted with these recognition items reduce any possible charges as much as possible; however, in the event that a country decides to assess fees on the package, these fees are non-reimbursable from LCIF. Once form is received by LCIF, please allow a minimum of 2-4 weeks for processing.

Please check the box below to proceed.

Please verify all information is complete before clicking on the submit button.

LCI and LCIF are Equal Opportunity Providers. Lions Clubs International Foundation (LCIF) is a 501(c)(3) tax-exempt charitable organization.

utm_medium

utm_source

utm_campaign

Cumulative Melvin Jones Fellowship (MJF) Credits Application

Submitter Information

Recipient Information

Shipping Information for Recognition