CONNECTICUT LIONS EYE RESEARCH FOUNDATION, INC.

Post Office Box 9268 New Haven, CT 06533 Telephone (203) 785-6121

 


Instructions: Do not use the ENTER or RETURN key. You may use the TAB key or mouse to move from one field to the next. Rather than leave fields blank, please enter "none" or "N/A" if this does not apply to your Lions Club. When you have completed filling the form, click on the "Send this Form" button.

This form may be used by any Lions Club member to order forms needed to support the Connecticut Lions Eye Research Foundation. Each Club President has/will receive a booklet that contains samples of most of the forms and brochures that the Connecticut Lions Eye Research Foundation has developed for it’s projects and programs. Some of these forms may also be downloaded from this Website. You may photocopy the forms for distribution to your club members or use the form below to order larger quantities from the CLERF office.


Club Name:

Date of Event:

Event:

Email Address:

Name:

Street:

City, State Zip:


Please indicate the number of forms requested:

Eye Donor Forms

Millennium Donation Forms

Recognition Program Forms

Knight of the Blind Applications

SightSaver Day Brochures

Special Interest License Plate Applications

Memorial Envelope

Comments or questions:


Please send your comments about this form to Lion Dan Uitti at dasum@freewwweb.com

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