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To recognize outstanding Lions and other deserving recipients, the Board of Trustees of the Montana Lions Sight and Hearing Foundation endorse this Fellowship. The Fellowship, which includes a lapel pin and a mounted certificate, may only be bestowed by a Lions Club, Lioness Club or an individual or group of individuals with a donation of two hundred fifty dollars made to the Montana Lions Sight and Hearing Foundation. Recipient: _______________________________________ Street Address: ___________________ City: __________ Zip: ______ Club Name: _____________________________________ ============================================================= Donor: _________________________________________ Street Address: ________________________ City: ________________ Zip: _______ Donation is from: ____ Individual ____ Club ____ District ============================================================= Mail Award to: ___________________________________ ___________________________________ ___________________________________ Please make check payable to Montana Lions Sight & Hearing Foundation. Send payment to:
Box 1266 Forsyth, MT 59327
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Dennis Kopitzke
