LIONS ALERT BANNER PATCH AWARD

Lions club, district, or multiple district ALERT

Committees must fulfill the award criteria below:

1. Meet with local authorities.

2. Coordinate a plan of action in the event
of a natural disaster, man-made disaster,
and/or a healthcare emergency such as
pandemic flu.
3. Develop a written Lions ALERT plan.
Include Lions assistance in the
community plan.
4. Submit the plan to Lion leaders for approval and signatures.
5. Submit the approved plan and this signed application to:

Lions Clubs International;

Program Development Department;
300 W. 22nd Street; Oak Brook, Illinois 60523-8842; USA
Fax number: 630-571-1672 E-mail: programs@lionsclubs.org

Check one box below:

□ LIONS CLUB (award will be mailed to the district governor for presentation)
Name of club __________________________________________________________________
Name of Lions ALERT chairperson_________________________________________________
Signature of Lions club president____________________________________________________
Name, address of district governor___________________________________________________
______________________________________________________________________________
Signature of district governor ______________________________________________________

□ LIONS DISTRICT (awards earned by districts will be mailed to the council chairperson for
presentation; awards earned by single districts that are not part of a multiple district will be mailed to
the district governor for presentation)
District number_______________________ _________________________________________
Name of Lions ALERT chairperson_________________________________________________
Name, address of council chairperson or district governor________________________________
_____________________________________________________________________________
Signature of council chairperson or district governor_____________________________________

□ LIONS MULTIPLE DISTRICT (award will be mailed to the council chairperson for
presentation)
Multiple district number__________________________________________________________
Name of Lions ALERT chairperson_________________________________________________
Name, address of council chairperson _______________________________________________
_____________________________________________________________________________
Signature of council chairperson ___________________________________________________