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Speaker Request Notification Form

Speaker Request Notification Form

  • Each district (single, sub and multiple) shall be allowed one official speaker for its convention or similar districtwide function, per fiscal year, from within their constitutional area.
  • The official speaking assignment must be for a districtwide function that represents the entire district, and an event in which all clubs within the district are invited to participate.
  • The host district (single, sub and multiple) will be responsible for all local expenses for the authorized speakers, including accommodations cost, meals and local transportation.  If a district fails to meet this obligation, the district will not be eligible for a speaker for future events until the debt has been paid.
  • This form must be completed by the District Governor, for district or sub district events, or Council Chairperson, for multiple district events, and must be submitted to the Travel Department at least sixty (60) days prior to the date of the function.
  • The sixty (60) day requirement shall be waived only in the event of an emergency requiring a substitute speaker or in cases where the second or third vice president or a first year director is requested for an authorized meeting scheduled for July, August or September.
  • Speaker photos and biographies are available for download from our website.
  • Acknowledgement of the receipt of the form will be sent out within 48 hours of receipt, to the District Governor or Council Chairperson.
  • For questions and information regarding speaker requests, please email us at speakerrequests@lionsclubs.org


Has an invitation been extended directly to the speaker and adult companion?

If YES, has the speaker accepted the invitation?

Date of Function:(//)
- -

(Ex: Convention, Meeting, etc.)

(hotel/motel name etc.)

Date(s) and time(s) speaker and adult companion are to appear on program:




If unable to attend all scheduled convention activities:


  Friday Saturday Sunday
Business Suit/Dress
Black Jacket
White Jacket
Cocktail dress
Full length dress

(i.e. membership growth motivation, membership retention, leadership)

Has this form been completed by the District Governor or Council Chairperson?

Please complete the contact information for the District Governor/Council Chairperson to be provided to your International Guest

Please provide a name and phone number for an emergency contact other than the District Governor/ Council Chairperson during the day of arrival of your International Guest

Please provide the name and phone number of the person meeting the speaker at the airport (if different from above)

Please Enter This Security Code Below: fiveninesixninenine

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