Cumulative 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 before submitting this application. If you need to confirm available credits or need help with this section, 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.

*denotes required field

(Please scroll over each item for clarification)

Melvin Jones Fellowship (MJF)

Progressive Melvin Jones Fellowship (PMJF)

MJF Credits To Be Used From

Club
District
Multiple District
Other

*Club Name

*Club Number

Club Officer Title Completing Form

*Officer Phone

*Officer Email

*Club City

Club State/Province

*Club Country

Recipient

Lion
Non-Lion

*Name

Is Recipient Deceased?Yes
No

Shipping Information for Recognition
**MATERIALS CAN NOT BE SENT TO P.O. BOX

ID Number

*Individual Name

*Address Line 1

Address Line 2

Address Line 3

*City

State/Province

*Country

Postal Code

*Daytime Phone

*Email

Special Instructions

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