Massachusetts Lions Youth Speech Competition STUDENT PROFILE
	Name: ___________________________________________________________________ Address: __________________________________________________________________ City, State, Zip Code: _______________________________________________________ Telephone: ________________________________________________________________ School: ___________________________________________________________________ Grade: _______________ Coach’s Name: ____________________________________ Sponsoring Lions Club: ____________________________________________________ Father or Male Guardian: ____________________________________________________ Address: __________________________________________________________________ City, State, Zip Code: _______________________________________________________ Mother or Female Guardian: _________________________________________________ Address: __________________________________________________________________ City, state, Zip Code: ________________________________________________________ School Activities and Offices: _________________________________________________ __________________________________________________________________________ __________________________________________________________________________ College Plans: _____________________________________________________________ __________________________________________________________________________ Future Aspirations: _________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Fill in sections that apply. Leave all others blank. You may use the other side.