RECYCLE FOR SIGHT MATERIALS ORDER FORM

[Pages:4]RECYCLE FOR SIGHT MATERIALS ORDER FORM

Lions Recycle For Sight promotional publications, and DVD can help to raise public awareness of your club or district eyeglass recycling campaign. The Information Kit (code KITRFS) contains samples of the program materials. Please use this form to order the materials you will need for your recycling campaign.

CODE NO. PUBLICATIONS

KITRFS

Lions Recycle For Sight Information Kit includes: Club Guide for Collecting Used Eyeglasses, Recycle For Sight pin and one sample of each: large and small collection box decals, window decal, community poster, brochure, club collection agreement form, collection location from, certificate of appreciation, press release and Lions Eyeglass Recycling Centers list. Recycle For Sight kit components are described below.

KIT COMPONENTS AND OTHER MATERIALS MAY BE ORDERED IN QUANTITY BELOW

IAD-402

Lions Recycle For Sight Community Poster: 8 1/2" x 11" (21.5 cm x 28 cm) full color poster for public display allows space for club personalization, (packet of 25 posters)

IAD-403

Lions Recycle For Sight Brochure: 4" x 9" (10 cm x 23 cm) colorful brochure for public distribution gives overview of Lions Recycle For Sight Program. (packet of 25 brochures)

IAD-401P

Lions Recycle For Sight Lapel Pin: Attractive 7/8" (2 cm) rectangular pin features the Recycle For Sight logo and recognizes Lions and others for outstanding support and contribution to the program.

IAD-405

Lions Recycle For Sight Certificate of Appreciation: 8.5" x 11" (21.5 cm x 28 cm) full color, prestigious certificate recognizes Lions, community residents, organizations or schools for outstanding collection efforts in the community. (packet of 25 certificates)

PRICE QUANTITY $5.00 ea ________

$1.50 pk ________ $1.50 pk ________ $1.00 ea ________ $1.50 pk ________

TOTAL COST ________

________ ________ ________ ________

CODE NO. PUBLICATIONS

PRICE QUANTITY

IAD28-DVD "New Glasses, New Life" DVD Presentation: 10 minute DVD presentation provides overview of eyeglass collection, processing and distribution to needy children and adults. Suitable for Lions and public viewing. (English)

$3.95 ea ________

IAD-410A

Large Eyeglass Collection Box Decal: Full color heavy stock adhesive back measures 8 1/2" x 11" (21.5 cm x 28 cm) and can be affixed to custom-made eyeglass collection box. (packet of 5 decals)

$2.00 pk

________

IAD-410B

Small Eyeglass Collection Box Decal: Full color heavy stock adhesive back measures 6" x 8.5" (15 cm x 21.5 cm) and can be affixed to custom-made eyeglass collection box. (packet of 5 decals)

$1.50 pk

________

IAD-410C

Eyeglass Collection Window Cling: Full color 11.375" wide x 5.5" high (28.8 cm x 13.9 cm) non-adhesive, vinyl static cling promotes collection location and can be easily placed and moved on glass surfaces. Features LCI logo and photograph of child wearing glasses.

$1.00 ea ________

IAD-410D

Eyeglass Collection Window Cling: Lions blue/gold 11.375" wide x 5.5" high (28.8 cm x 13.9 cm) non-adhesive, vinyl static cling promotes collection location and can be easily placed and moved on glass surfaces. Features LCI logo, no photograph.

$1.00 ea

________

G1174DS

Eyeglass Collection Boxes Attractive, easy to assemble boxes in Lions blue and gold with official Lions Recycle For Sight logo. Each box measures 12" wide x 8" deep x 8" high with a header panel. Sold in package of 10 only. Allow 3-4 weeks for delivery. Product ships separately from outside vendor.

$71.30 pk ________ Set of 10 boxes

[Vendor's price subject to change.]

TOTAL COST ________

________ ________ ________

________

________

CODE NO. PUBLICATIONS

PRICE QUANTITY

TOTAL COST

IAD-19

Hearing Aid Recycling Decal (small): Full color

$1.50 pk

heavy stock adhesive back measures 8 5/8" w x 2 1/4" h

(22 cm x 5.7 cm) can be used on a separate box or on

header panel to convert the Eyeglass Collection Box

(G1174DS) for both eyeglass and hearing aid collection.

(packet of 5 decals)

________

________

IAD-401

Club Guide for Collecting Used Eyeglasses: 8.5" x 11" (21.5 cm x 28 cm) guide can help club to begin and maintain successful collection activity.

$1.50 ea ________

________

IAD-411

Recycle For Sight Sample Press Release: Promote your eyeglass recycling efforts and inform community members how they, too, can participate in the program.

Available to download online Sample included in Recycle for Sight Kit.

IAD-408

Lions Eyeglass Recycling Centers List: List contains contact information for each of the Lions Clubs International official eyeglass recycling centers.

Available to download online Sample included in Recycle for Sight Kit.

IAD-404

Lions Recycle For Sight Collection Location Form: Submit completed form to LCI. Confirms club's participation in Recycle For Sight Program and provides information for posting collection sites on LCI Web site.

Available to download online Sample included in Recycle for Sight Kit.

IAD-406

Lions Recycle For Sight Collection Agreement: Recognizes cooperation and commitment between Lions and the participating organization in support of Recycle For Sight activities.

Available to download online Sample included in Recycle for Sight Kit.

SUBTOTAL OF MATERIALS ORDERED (US$)

________

SEND MATERIALS TO: Name: ___________________________________________ Lions Title: ____________________________________

Address (not a P.O.Box): ____________________________________________________________________________

City: ___________________________ State/Province: ________________ Country: ___________________________

Postal Code: ________________ Daytime Phone: __________________________ Fax:________________________

E-mail: ____________________________________________________________________________________________

Club Name or MD/District: __________________________________________________________________________

Select Language Desired: I CH I EN I FI I FR I GE I IT I JA I KO I PO I SP I SW

I I I I I I I Account Number:

Bill to club:

I Bill to

District:

I Bill to

Multiple District:

Date Ordered:__________________________________ Date needed: ______________________________________

Note: Allow 3-4 weeks for delivery.

NOTE: Do not send cash. All orders must be billed. No direct payments can be processed at time of order. To pay after order has been expedited, please contact Accounts Receivable. Shipping/handling charges will be added at time of processing. All orders subject to applicable taxes, if any.

Authorized signature: ________________________________________________________________________________ Only the current club president, club secretary or club treasurer may authorize billing to their club. Only the current district governor or cabinet secretary may authorize billing to their district. Only the current council chairperson or multiple district secretary may authorize billing to their multiple district.

Please submit form to:

Health and Children's Services Department Lions Clubs International 300 W. 22nd Street Oak Brook, IL 60523-8842 eyeglasses@ Fax: 630.571.1692

CARE

GIVE

RECYCLE

IAD-409 7/14 EN

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