Leo Club Program Advisory Panel

First Name*

Last/Family Name*

Lions International Member ID*

(Note: If you don’t know this, ask your Leo club advisor.)

Leo Club Name*

Leo Club Number

Lions District*

Date of Birth*

Country*

Select the constitutional area in which you reside:*

CA I – U.S. and Affiliates, Bermuda and BahamasCA II – CanadaCA III – South America, Central America, Caribbean & MexicoCA IV – EuropeCA V – Orient and Southeast AsiaCA VI – India, South Asia and the Middle EastCA VII – Australia, New Zealand, Papua New Guinea, Indonesia, S. PacificCA VIII – Africa

Email*

example@example.com

Mobile Phone Number

What is the highest position you’ve held as a Leo?*

Are you able to commit to meeting throughout the year via web conference and/or in person? This includes monthly panel meetings, as well as multiple committee and constitutional area meetings.*

YesNo

All Leo Advisory Panel communications and meetings will be held in English; resources will be provided in English. Do you feel comfortable speaking, writing and reading English? *

YesNo

Do you speak, write and/or read another language in addition to English?

YesNo

Please list them along with proficiency level.

Are you able to attend your Leo or Lion Constitutional Area Forum during the 2027 and 2028 fiscal year?

YesNo

How has the Leo Club Program impacted your life? *

0/300

Why do you think you would be an effective member of the Leo Club Program Advisory Panel? *

0/300

Share examples of how you have worked with the Leos and Lions in your district, multiple district and/or at the international levels.*

0/300

Please include any additional information to assist with the selection process.

0/300

Leo Advisory Panelist information will be published on the Lions International website and social media platforms. This information may include your name, club name, multiple district/district, country, biography, email address and photos submitted and taken if you are appointed and accept participation in this program. Choose one.*

If appointed and upon my acceptance in this program, I give my consent to publish the information as described above on the Lions International website and social media platforms.If appointed and upon my acceptance in this program, I do NOT give my consent to publish the information as described above on the Lions International website and social media platforms.

Leo Club Program Advisory Panel

For the term beginning July 1, 2026 and ending June 30, 2028