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Vision Assistance Application
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Vision Assistance
Vision Assistance Application
Thanks! Your application will be sent the Lions Club closest to you for assistance review.
Full Name
*
Date of Birth
*
Phone Number
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Email Address
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Address City State Zip
*
Last known eye exam
*
Do you have health insurance?
*
What do you need assistance with?
*
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South Dakota Lions Foundation
Programs
Eyeglass Donations
KIDSIGHT Vision Screening
Hearing Aid Donations
Vision Assistance
Other Programs
