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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