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Trustee Application

Please note:
Submissions subject to approval. Your information will be reviewed and we will contact you upon approval.

First Name (*)
Please let us know your First Name.
Last Name (*)
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Your Email (*)
Please let us know your email address.
Primary Phone (*)
Please tell us a number where you can be reached
Street (*)
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City (*)
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State (*)
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Zip (*)
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Are you a Lion ? (*)
Please indicate your if you are a Lion
Club Name
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Which district are you a member of?
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Any additional Info
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Security Code (*) Security Code
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Contact Info

 LPCCI is a non-profit organization formed in 1983 to educate, raise funds and to seek puppy raisers for Canine Companions for Independence.

   707-577-1774    1-877-865-7224


LPCCI National Office P. O. Box 3896
Santa Rosa
Ca 95402