WISCONSIN LIONS FOUNDATION INC
WISCONSIN LIONS FOUNDATION INC.
EYEGLASS RECYCLING CENTER
3834 COUNTY ROAD A ROSHOLT WI 54473
1-715-677-4969 1-715-677-4527 (FAX)
EMAIL: wilionserc@
MISSION EYEGLASS DISTRIBUTION REPORT
MISSION/ORGANIZATION NAME _____________________________________________________
MISSION/ORGANIZATION ADDRESS___________________________________________________
MISSION/ORGANIZTION CONTACT PERSON___________________________________________
MISSION DATE FROM____________________________ TO _________________________________
CITY OR COUNTRY RECEIVING GLASSES_____________________________________________
NUMBER OF GLASSES TAKEN TO THE MISSION_______________________________________
NUMBER OF PEOPLE SERVED ON THE MISSION_______________________________________
NUMBER OF PEOPLE FITTED WITH GLASSES__________________________________________
WERE LOCAL LIONS INVOLVED IN THE DISTRIBUTION? YES____________ NO________
PERMANENT DISTRIBUTION CLINIC? YES___________ NO________
Please return this report within two weeks of the completion of the mission to:
Wisconsin Lions Foundation, Inc.
Eyeglass Recycling Center
3834 County Road A
Rosholt WI 54473
Questions regarding this report should be directed to Liz Shelley, WLF Administrative Assistant
Failure to return this report may result in denial of future requests for mission eyeglasses.
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