North Citrus Region

Supplemental District Report (SDR)

CLUB NAME:

Select Your Club

CLUB CATEGORY:

Select Category

REPORTING PERIOD:

MonthYear

1.MEMBERSHIP:

Beginning
Total / Members
Added / Members
Dropped / Members
Deceased / Transfer
IN / Transfer
OUT / Ending
Total / Lioness
Club Total / Leo’s Club Total
  1. NEW Member Training:

Date of Session / Potential Member Attendance / New Member Attendance / Visitors Attending / Members Attending
Recruitment Sessions
Orientation of New Members
Prompt Inductions [Within 60 Days]

3. MEMBERSHIP AWARDS:The number of awards given this month

Proud Lion / Date Awarded /
Key Award
/
Date Awarded
/
District Award
/
Date Awarded
/ International Award / Date Awarded

4. Programs at Club Meetings this month:

Date / District 4-L5/MD-4 Lions Project / Outside Organization Name

5. CLUB NEWSLETTER/BULLETIN ISSUED THIS MONTH: Yes No

Send Copies of Newsletter/Bulletin to: Governor, 1st & 2nd Vice-Governor, Cabinet Secretary, Region Chairperson, Zone Chairperson, Lions Pride Editor, Public Relations/Publicity Chairperson and Special Awards Chairperson

  1. CLUB BROCHURE: Yes No(one time only)

Send Copies of Brochure to: Governor, 1st & 2nd Vice-Governor, Cabinet Secretary, Region Chairperson, Zone Chairperson and Special Awards Chairperson

  1. WEB SITE Yes No(one time per year) Site address ______
  1. CLUB VISITATIONS

# Official Club Visits / Club # Visited / Date of Visit / # of Members Attending each visit / # of Un-Official Club Visits / Club # Visited / Date of Visit / # of Members Attending each Visit
  1. PUBLIC RELATIONS ARTICLES ATTACHED: Yes No # Attached

Credit will not be given unless the Lions Club Name specifically mentioned. Include date and name of paper.

Send Copies of Public Relations Articles to: Public Relations/Publicity and Special Awards Chairpersons, District Governor, 1st VDG, 2nd VDG, Cabinet Secretary, Cabinet Treasurer, Region Chair, Zone Chair

10A. COMMUNITY SERVICE HOURS

i.e. California Lions Friends in Sight and Leo Clubs / LionessService projects and NOT fund raising projects.

Description of Community Service
/
Date
M/D/Y /
# of Members
Participating / Service Hours
Worked

10B. VOLUNTEER HOURS:

i.e. Church/Thrift store and Leo Clubs / Lioness Volunteer Hours and NOT Service projects or fund raising projects.

Description of Volunteer Hours
/
Date
M/D/Y /
# of Members
Participating / Hours
Volunteered

11.SPECIAL LIONS PROJECT:Guide Dogs/Canine Companions/Youth Exchange (one time per year)

PUPPY RAISERS:Yes No

SERVICE DOGS:YesNo

YOUTH EXCHANGE:YesNo

12.FUND RAISING PROJECTS: Lions, Lioness, and Leos activities intended to raise funds

Project Description / Date
M/D/Y / Members
Participating / Hours
Worked / Amount
Earned

13. CHARITABLE DONATIONS:

Project Description / Date M/D/Y / Amount Donated/Value of Amount Donated

Monetary donation Lion, Lioness and Leo project by your Club[notby individual members]

14A. DISTRICT OUTREACH ACTIVITIES:

Mark each activity in the month of contribution for activities that you participate in or sponsor.

Name / Date / Amount / Name / Date / Amount
CA Lions Foundation / Lions Diabetic Camp @ Teresita Pines
California Lions Friends in Sight (CLFIS) / Lions Sight & Hearing Foundation of Southern California
City of Hope / Loma Linda Lions Eye Foundation
Diabetes Awareness / MD-4 Youth Exchange Foundation
District 4-L5 Disaster Fund / Rose Parade Float
Flag Day / Scouting
Guide Dogs of the Desert / Student Speaker Contest
Hearing Foundation / Student Speaker Foundation
LCIF / World Services for the Blind
Leo Club
Lioness Club / Youth Exchange Sponsor / Summer ------
Winter ------
Lions in Sight / Host / Summer ------
Winter ------
Lions Camp of Teresita Pines

14 B. CENTENNIAL DISTRICT OUTREACH ACTIVITIES:

Mark each activity in the month of contribution for activities that you participate in or sponsor.

Name / Date / Amount / Name / Date / Amount
Adopt a Highway Program
(Environment) / Kids Produce Market
(Hunger)
California Lions Friends in Sight
(Vision) / Lions KidSight USA
(Youth)

15. ACTIVITIES SUPPORTING OTHER LIONS CLUBS:

Events Within District 4-L5 / DateM/D/Y / Total Attendees
Events Outside District 4-L5
Date
Amount

16. GOVERNOR’S PROJECT: Canine Companions for Independence (1 Point Per $)

17. HOST DISTRICT, REGION OR ZONE MEETING:

Mark only the meetings that your club hosted or co-hosted

Zone / Region / District /

Date

Mm/dd/yy

18. Attendance at Conventions and Special Seminars:

Date
M/D/Y / Name of President Attending / Name of Secretary Attending / Number of Other
Members Attending
Cabinet Installation
Club Retreat
District Cabinet Meetings
District 4-L5 Convention
District 4-L5 Seminar GMT/GLT Training
District 4-L5 Training
Global Membership / Global Leadership Training(GMT/GLT)
International Convention
MD-4 Convention
MD-4 Leadership Training
Zone Meeting
Region Meeting
USA/Canada Forum

19. INTERNATIONAL and MD-4DUES and BILLINGS PAID

Remember to follow up with your Treasurer to make sure these are paid on time

Date Paid / Amount Paid / Check # / Paid Within
15 days of Billing
International Dues / July
Jan
New Members / Yes
No
MD 4 Dues / Aug
Feb
New Members / Yes
No
Supplies / Yes
No
Date
Date
Date
Date

20. SPONSORED NEW LIONS CLUB:Yes No

21.SPONSORED NEW BRANCH CLUB:Yes No

22.SPONSORED NEW LEO CLUB:Yes No

23. SPONSORED NEW LIONESS CLUB:Yes No

24.MONTHLY MMR AND SDR FILED ON TIME:

Computer MMR (Monthly Membership Report), Service Activities Report, and SDR (Supplemental District Report) submitted electronically last day of month. YES NO

****April each year on the LCI Web Site log in on MyLCI, on upper left corner My Tasks will instruct secretaries to enter New Club Officers (PU101) for upcoming year. YES NO

25. EYEGLASSES:

Number / # Members / Hours / Cost to Club
25 A. Used Eyeglasses Collected / Donated this month
25 B. New Eyeglasses Provided this month
25 C Recycling Processing Center Volunteer (hours)

27. 26. HEARING AIDS AND CELL PHONES:NewUsed

Hearing Aids donated this month
Cell Phones donated this Month

27. DISTRICT CABINET/COMMITTEES:Each official position list only once. (Credit given only once)

Name / Cabinet Position / Committee Chairperson / Committee Member

28. place the totals of all items for this MONTH IN the Table below.

Total Service Hours / Total Money Donated / Total Money Earned / Total Units Donated
Add lines 10A & 25C / Add lines 13,14A, 14B, &16 / Line item12 / Add lines25 A & 26

Did you remember to attach your International Monthly Membership Report (MMR)? YES NO

Did you remember to attach your International Service Activities Report? YES NO

Did you remember to attach your Supplemental District Report (SDR)? YES NO

Report Submitted By:Date: ______

Club Secretary: ______

Club President: ______

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