New Leads Form

Note: Use this form to submit leads for new clubs to District 27's Lt. Governor Marketing and their team. They will get back to you about your lead as soon as possible. * Indicates required information Information About You *Name: Street Address: Street Address - 2: City: State: VA MD DC *Email: *Phone: Please give us as much information as you can in the following boxes:. Name and Location of Organization: Organization's Contact Name, Phone Number & Email Address: If you know someone in the organization for us to contact who will help form this club enter their contact information here. My Interest in Forming this New Club: Please indicate below anything you will do to get this club going, such as if you will participate in the initial demonstration meeting, help coordinate and plan subsequent meetings, or will serve as a Club Sponsor or Club Mentor. Other Comments:

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