Membership Enrollment Application | The Lions Club of Palani Thangaratham

🦁 New Member Enrollment Application

Please complete all 15 official membership registration parameters below. Your application will appear directly on the administrative review queue for verification and induction.

Part A: Personal Bio-Data & Demographics

1. Prefix / Salutation *

2. Full Member Name * Please enter your full name.

3. Father's Name * Please enter father's name.

4. Gender *

5. Blood Group *

6. Date of Birth * Applicant must be at least 18 years of age.

7. Spouse Name

8. Wedding Anniversary

Part B: Contact, Vocation & Sponsorship

9. Mobile Number (WhatsApp) * Valid 10-digit mobile number required (starting with 6-9).

10. Official / Personal Email * Valid email address required.

11. Profession / Occupation * Occupation is required.

12. Referred / Sponsored By

13. Residential / Business Address * Address is required.

14. Why do you wish to join Lions Club? * Reason for joining is required.

Part C: Photograph Attachments (Offline Max 3 MB Each)

MEMBER

15. Member Passport Photo

JPG, PNG, or WebP (Max 3 MB)

FAMILY

Family Archive Photo (Optional)

JPG, PNG, or WebP (Max 3 MB)