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TEXAS LIONS MUSEUM
AND
OFFICE FOUNDATION, INC.
Application for Everett J. Grindstaff Fellowship or Life Membership
Please check one: Fellowship ($500)
Life Membership ($100)
Donor Information:
Multiple District _________________ District _____________ Other __________________
Club Name and City _____________________________________________________________
Purchaser ______________________________________________________________________
Recipient Name _________________________________________________________________
(please print as it should appear on plaque and/or certificate)
Mailing Address ________________________________________________________________
(physical address)
______________________________________ ____________ __________
(city) (state) (zip)
Special Instructions: _____________________________________________________________
______________________________________________________________________________
------------------------------------------ Payment Information ------------------------------------
Check No. ______ payable to Texas Lions Museum and Office Foundation, Inc.
OR
Credit Card No. __________________________ Expires__________ CVV ____
Return to: MD2 Texas Lions State Office P.O. Box 294509 Kerrville, Texas 78029