|APPLETON NOON LIONS CLUB
MONDAY NOON GRAND MERIDIAN
P. O. BOX 762, APPLETON, WISCONSIN 54912
Are you eligible for government assistance? (DVR-Social Services-VA, etc;) yes - No
Note on the back of the form any other information as you see fit.
Please return to the address above. We will be in contact with you
as soon as possible.
--Appleton Noon Lion's Club Thank you!
Form submitted by:
Name_____________________ Title___________ Phone no._________________