Eyeglass Delivery/Donation Form

[Pages:1]9013 Mullen Road SE Olympia, WA 98513 360-923-2075

Eyeglass Delivery/Donation Form

Date:

Lions Club:

Zone & District:

Complete Mailing Address:

Contact Person:

Email Address:

Phone Number: Eyeglass Count: Comments or Notes:

NWLERC Form #2 Revised 11/10

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