North Carolina Lions Hall of Fame Nomination Form

The District Governors of North Carolina are requesting nominations of outstanding Lions to be considered for induction into the North Carolina Lions Hall of Fame.

Purpose: The mission of the Hall of Fame is “to honor in perpetuity those Lions whose contributions to Lionism in North Carolina have been of great value.

Criteria: Nominees may be living or deceased. Their contribution(s) should be of enduring value and of major importance to furthering the goals of Lionism in North Carolina.

Instructions: Complete the following in its entirety and submit to your District Governor.

Deadline for Submission: January 31, 2012

1. Name of Nominee: __________________________________________________________

2. Lion’s Title: _________________________________________________________________

3. Date of Death, if applicable: ___________________________________________________

4. Biographical Information of Nominee: (Include name of Lions Club, years of service, leadership positions held, honors, and awards. Add additional pages as needed).

5. List major accomplishments and/or contributions: (Add additional pages as needed)

6. Describe the value and significant impact of the nominee’s contributions to the goals and objectives of Lionism in North Carolina. (Describe how the accomplishments have been relevant and valuable to the North Carolina Lions).

Nomination submitted by: (please print) ______________________________________________

Address of Submitter: ________________________________________________________

Home Telephone: __________________________

Cell Phone: _______________________

Signature of Submitter: _________________________________
Date: ________________

Nominations need to be sent to D. Buchter PO box 816 Whiteville, NC 28472


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