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Vision Van Request Form

Vision Van Screening Request Form

This is the form for requesting the vision van for your club.

Step 1 of 2

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  • Lions Club Information

    All the information on this page pertains to your club and the club member requesting the Vision Van.
  • Enter the name of your club.
  • The number starts with 43. S
  • This is the person in charge of the vision screeing event that you are using the van for.
  • The phone number for the person in charge of the vision screening event that you are using the van for.
  • The conformation will be sent to this e-mail address.
  • The city your club is located.
  • The county your club is located in.

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