Awards, Applications and Forms

November 2018

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100th Annual MD5M Multiple Convention

Awards, Applications and Forms

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2019 5M11 MidWinter Convention February 1, 2 & 3, 2019 - Winnipeg, MB. CO-HOSTED by: Winnipeg West Lions & Winnipeg South Lions Clubs Location: Holiday Inn Airport (Polo Park) Ð 1740 Ellice Ave, Winnipeg, MB R3H 0B3 Early Bird Saving! Hotel rooms booked before December 1, 2018, room rate will be: $114.00 CDN Ð (plus taxes). Rooms booked after December 1, 2018 room rate will be: $125.00CDN Ð (plus taxes)

HOTEL BOOKING CALL: Direct 1.204.775.5055 or Email: guest.services@holidayinnpolopark.com

ÒRemember to ask for 2019 Mid-Winter Convention Block Code # LIONS Registration Form Ð One Per Attendee Club Name: __________________________________________ District : ___________ Lion

Lioness

Leo

Guest

1st Timer

Registration form available on the website WWW.5m11 website

Name & Title: Address: City/Town: State/Prov:

Please advise the hotel if you need a handicap room or access within the hotel

Zip/Postal: Phone (w / area code): Email:

Special Dietary Needs: Vegetarian, Gluten Free, Allergies: _________________________________________ I am attending the convention but NO meals are required, $0.00 cost to attend EVENTS:

Before Dec. 1st 2018

Early Bird Saving! Full Hospitality Book

$125. CDN / $100. USD

After Dec 1st 2018

$ AMOUNT

$135. CDN/$115.USD

(Full Hospitality Book (access to ALL events; Friday night Mingle, Saturday Breakfast, Lunch, Banquet & Sunday Breakfast & includes all taxes & gratuities) # of meals Total INDIVIDUAL EVENTS:

Friday Night Mingle

$20.00 CDN

Saturday Breakfast

$20.00 CDN

Saturday Lunch

$25.00 CDN

Saturday Banquet

$65.00 CDN

Sunday Breakfast

$20.00 CDN

Make cheques payable to: Ò2019 5M11 Midwinter ConventionÓ Mail registration form & payment to: Winnipeg

West Lions Club, Unit 101 - 3590 Portage Avenue. Winnipeg MB. Canada R3K 2J1. For Convention Information contact: Lion Kevin Gamble Ð email: kbgamble@ Hotmail.com Ð phone: 1.204.806.6339. PLEASE NOTE: Cancellations prior to December 1, 2018 will have a $25.00 fee applied, NO Cancellations after December 1, 2018, except for Medical emergencies which are accepted anytime with doctors letter ($25.00 fee still applies).

“Catch the Sweet Deal” and join us for the 100th Birthday Party of MD5M

th

100 Annual MD5M Multiple Convention April 26th, 27th & 28th 2019, Mahnomen, MN, USA

Your District & Club Name: _______________________________________________________________ Lion ___ Lioness ____ Leo ____ Guest ____ 1st TIMER ____ Title & Name________________________________________________ Address ________________________________________________

Registration form also on http://www.lionsmd5m.org

City/Town ________________________________________________ State/Prov. ________________________________________________ Zip/Postal ________________________________________________

“Will you require Braille Documents at the convention? _______

Phone (w/area code) _________________________________________ Email _______________________________________________ Special Dietary Needs: Vegetarian, Gluten Free, Allergies ___________________________________________ I am attending the convention, but NO meals are required, $10.00 cost to attend ____ (Name Tag & Pin) Full Hospitality Book (Includes Friday night Social, Saturday Breakfast, Lunch, Banquet & Sunday Brunch) EVENT Before March 1, 2019 After March 1, 2019 # ATTENDING $ AMOUNT Full Hospitality Book $ 95. USD $ 120. CDN $ 105. USD $ 130. CDN __________ __________ Friday Night Social $ 15. USD $ 20. CDN $ 20. USD $ 25. CDN __________ __________ Saturday Breakfast $ 20. USD $ 25. CDN $ 25. USD $ 30. CDN __________ __________ Saturday Lunch $ 25. USD $ 30. CDN $ 30. USD $ 35. CDN __________ __________ Saturday Banquet $ 40. USD $ 45. CDN $ 45. USD $ 50. CDN __________ __________ Sunday Brunch $ 30. USD $ 35. CDN $ 35. USD $ 40. CDN __________ __________ ***NO Meals available after April 22, 2019*** Totals __________ __________ Make checks payable to: Vergas Lions Memo: 2019 MD5M Convention Mail form & payment to: Linda Norby, 1021 5th Avenue NW, Perham, Mn. 56573

For Convention Information contact: PDG Rodger Palmer, repotter@eot.com or phone 218Ͳ841Ͳ0302 or PDG Jay Norby, ljnorbs@eot.com or phone 218Ͳ298Ͳ1041.

Check our website for information & updates on the 2019 MD5M Convention, lionsmd5m.org

Lions 5M11 District Governor Club Visitation Request Form 2018-2019

Today’s Date_____________________ Club:______________________________________ Preferred Date_________________________ Alternate Date:_________________________ Person Requesting___________________________ Phone #___________________________ If more than one club will be attending, please include the names of all clubs: ____________________________________________________________________________ ____________________________________________________________________________ Meeting Time:______________ Social Time:_____________ Dinner Time:_______________ Is Spouse invited:____________ Other District Officers invited:________________________ Location:____________________________________________________________________ Lions Contact Person for visit:____________________________________________________ Phone:______________________________ Cell:_______________________________________ E-Mail:__________________________________ Special requests: (Ex. Special Speech, induction of new members, installation of officers, present awards, etc.)

Please submit as soon as possible. I will confirm date with contact person either by phone or e-mail as soon as possible after request is received.

Please send this information to: DG Bill Myskiw R. 204-339-1242 C. 204-782-1416 Email: wjmyskiw@shaw.ca

2018-2019 CLUB EXCELLENCE AWARD APPLICATION Club must be chartered prior to January 1 of the fiscal year to qualify.

Club Number

Application Date

Club Name

Member Number

2018-2019 Club President’s Name

2018-2019 Club President’s Email Address 1.

MEMBERSHIP

2.

Achieved a Net Growth of: ____________ *

OR

SERVICE

Started a new service project. Consider one of our

Global Causes!

Chartered new Lions club or Club Branch: Name of club or branch: ________________________ AND

1.

____________________________________________

2.

____________________________________________

3.

____________________________________________

Supported member retention by increasing member satisfaction

OR Organized a new Leo Club

Outline strategy: ____________________________ _________________________________________ _________________________________________

AND Contributed to LCIF

*Based on June 30 cumulative membership report

3. ORGANIZATIONAL EXCELLENCE Club is in Good Standing: Not in Status Quo or Financial Suspension. District dues paid and no unpaid balance with LCI greater than US$50 outstanding 90 days or more.

AND Key Officers participate in one or more of the following leadership training events:

4.

MARKETING AND COMMUNICATION

The club has publicized its service activities through local media or social media as noted below: _________________________________________________________

___________________________________________ ___________________________________________

District Multiple District International Webinars Lions Learning Center Club Quality Initiative

The club utilized social media to promote club activities and reported to Lions Clubs International as noted below:

AND Improved club operations Improvements Include: __________________________________ ______________________________________________________ ______________________________________________________

Date

OR

_________________________________________________________ _________________________________________________________ _________________________________________________________

2018-2019 District Governor’s Signature*

District

Member Number

Due by: August 31, 2019 Send to: clubexcellenceaward@lionsclubs.org or fax to (630) 706-9245 Awards Mailed to: 2019-2020 District Governors

*If sent from district governor’s registered email, it qualifies as signature on applications submitted electronically.

Disqualified clubs have 12 months from original due date to request a review.

DA-1.EN 4/18

NOMINATION

FOR STEW PEEVER MEMORIAL AWARD 2017/2018

Send nominations to: Lions Eye Bank 320 Sherbrook St. Winnipeg, MB. R3B 2W6 Fax 204-943-6823 lfmnoi@mts.net Deadline: January 2, 2017

To all Lions Club Members in District 5M-11: It’s that time of year again! The Lions District 5M11 Midwinter Convention is approaching and we at the Lions Eye Bank of Manitoba and Northwest Ontario Inc., are preparing to award a Lion or non-Lions member with a plaque that signifies his or her outstanding support to the Lions Eye Bank and its programs - this includes the annual fundraising event the Journey for Sight.

Enclosed you will find an application for nominations for the Stew Peever Memorial Award.

This award is presented to those whom have provided outstanding service to the Lions Eye Bank and/or the Journey for Sight. One award for each district will be presented at the Midwinter Conventions.

SUBMITTING A NOMINATION: 1. Include the name and phone number of the individual or club representative submitting the nomination.

2. Type or print clearly on the nomination form.

3. Attach supporting documentation describing the volunteer efforts. Any additional information such as newsletters, press clippings, photos, letters, etc., to support the nomination would be useful and welcome. Materials submitted will be returned on request.

4. If your club had previously forwarded an application in a previous year, and would like to re-submit, please fill out the attached form.

DEADLINE FOR APPLICATIONS: The deadline for the applications is January 2, 2017 THE AWARD PRESENTATION: The award will be presented to the selected recipient at the Lions Mid-Winter Conventions in all three districts.

If anyone has any questions contact your local Lions Eye Bank Director or call the Lions Eye Bank office @ 1-800-552-6820 or 772-1899 or e-mail lfmnoi@mts.net. Thank you for your support.

NOMINATION

Send nominations to: Lions Eye Bank 320 Sherbrook St. Winnipeg, MB. R3B 2W6 Fax 204-943-6823 Email lfmnoi@mts.net Deadline: January 2, 2017

FOR STEW PEEVER MEMORIAL AWARD 2017/2018 NAME OF NOMINEE: __________________________________________________________________ ADDRESS OF NOMINEE: ______________________________________________________________ NOMINATING LIONS CLUB:____________________________________________________________ ADDRESS OF LIONS CLUB:____________________________________________________________ PHONE # AND CONTACT NAME:________________________________________________________ THIS APPLICATION HAS BEEN APPROVED BY MY LIONS CLUB:

YES______

Please describe the contribution of the nominee:

___________________________ President’s Signature

__________________________ Secretary’s Signature

Heart of a Lion Award Application This Award is for 5M11 lions that meet the criteria below. A lion member may apply or a club may apply on behalf of a member. Applications can be turned in throughout the year. Awards will be awarded at Mid-Winter Convention or at Governors meetings after Convention. This award can be earned over several years.

A Lion Member must MEET 7 of the 10 CRITERIA listed below to RECEIVE the AWARD! Name:____________________________________ Club______________________________ (Name of Lion Member) ______ Sponsored a new Lion ___________________________Club_____________________ (Name of new member) ______Attended a Zone Meeting_________________________________________________ ( What Zone and date attended Zone meeting) ______Attended 5M11 Convention. ______Served as a Club officer or District Cabinet Chairperson.________________________ (last position held) ______Be a Chair or Co-Chair of a club or District Project. ____________________________ ( What was the project) ______Attended one training event: Officer Training, Leadership Training or other Lions Clubs International sponsored class. __________________________Date_______________ (Training Attended and date) ______USA/Canada Lions Leadership Forum, International Convention or Multiple Convention. ______Promote a new idea, service project or fundraiser that is adopted by your club or District that meets the mission of Lions. ____________________________________ (Promotion idea and date) ______Attend 5 or more club events _____________________________________________ ___________________________________________________________________ ( Events attended either your club or another club) _______Attend a club meeting of another club______________________________________ (what club) Original to be completed and turned into the District Governor or District Administrator.

Signature of District Governor or District Administrator. _______________________Date__________

MD5M Hall of Fame Award Purpose To honor those Lion and Lioness members of character and substance who have demonstrated the highest level of commitment and dedication to the efforts of their club, district or multiple district and the motto of our association, “We Serve.” Award There will be a maximum of one (1) recipient of the MD5M Hall of Fame Award per district, inducted into the MD5M Hall of Fame each year. The award may be presented posthumously Exception: During the 2003-04, 2004-05 and 2005-06 Lion years, each district will be allowed two (2) Hall of Fame recipients, at least one (1) of which must be honored posthumously. Following the 2005-06 Lion year, beginning in the 2006-07 Lion year, the number of Hall of Fame recipients per district will return to one (1) per district. The MD5M Hall of Fame award recipients are to be inducted into the Hall of Fame at the annual MD5M Multiple District Convention during the Saturday noon luncheon. The first honorees will be inducted May 21-23, 2004 at the MD5M Multiple Convention.

MD5M Hall of Fame recipients will receive a MD5M Hall of Fame award plaque and a Hall of Fame lapel pin in recognition of their induction in the MD5M Hall of Fame. In addition, a complete listing of all MD5M Hall of Fame recipients will appear in the annual MD5M directory and a perpetual plaque, with the names of all inductees and the year of their induction inscribed thereon, will be kept in a prominent place in the MD5M office, when available. The presentation of the MD5M Hall of Fame inductees will be the responsibility of the current International Director from MD5M, if there is one and he/she is in attendance at the MD5M Multiple District Convention. If not, then the most recent Past International Director having served from MD5M in attendance at the MD5M Multiple District Convention. Criteria A candidate may be a Lion or Lioness, must have been a member in good standing for at least 15 years, be at least two (2) years removed from the Council of Governors if a PDG, should have qualifications above and beyond the call of duty including social and human endeavors, and he/she should be of good moral character and have a good reputation in his/her community. A nominee must be a member in good standing of a Lions or Lioness Club in MD5M, or must have been a member in good standing of a Lions or Lioness Club in MD5M at the time of their death. Process A candidate may be sponsored by any Lion, Lioness, Lions Club, Lioness Club, Zone, or District.

There will be a nomination fee of $150.00 per each candidate nominated. The nomination fee will be returned to those sponsors whose candidates are not elected for induction into the MD5M Hall of Fame. The nomination fee for those selected for induction will be sent to MD5M and will be used to offset the cost of the award process, plaques and pin.

Nominations, including the nomination fee, must be received by the District Governor at least 30 days prior to the District’s Mid-Winter Convention.

Each individual District will annually hold an election at their Mid-Winter Convention to determine the candidate(s), if any, to be inducted into the Hall of Fame for that Lion Year. Each sponsor will have an opportunity to give a brief presentation on the merits and biographical information of their nominee prior to the election. Those elected to be inducted into the MD5M Hall of Fame will not be announced until their induction at the MD5M Multiple District Convention.

All nominations will use the standard form, no others will be accepted. The nomination fee must be received at the time the application is received, otherwise the nomination will not be considered.

All successful candidates will be inducted into the MD5M Hall of Fame at the next MD5M Multiple District Convention. The sponsor(s) and the respective District Governor will ensure that the honoree or a suitable representative be in attendance at the MD5M Multiple District Convention when the honorees are inducted.

A brief biography of each inductee shall be announced to those in attendance during the induction ceremony at the annual MD5M Multiple District Convention.