Glema Mahr ÐÓ°ÉÂÛ̳ Lions Club Eye Care Application
For ÐÓ°ÉÂÛ̳ Students or ACE2 students in need of an Eye Exam and/or new prescription eyeglasses. Students will be referred to Lion Dr. Troy Crist at Multicare Eye Clinic in Madisonville, KY.
Important Notice: A cap of $215 exists for eyeglasses. Any amount over $215 will be the student™s responsibility payable to Dr. Crist.
Recipients will also receive an invitation to a ÐÓ°ÉÂÛ̳ Lions Club meeting for a photo opportunity which the photo can be put in a newsletter.
Mail or fax a copy of insurance card to:
Mail, fax or email completed application to:
Sharon Fugate
Eyesight Committee Chair
ÐÓ°ÉÂÛ̳ Lions Club
ÐÓ°ÉÂÛ̳
2000 College Drive
Madisonville, KY 42431
270-824-1832
sharon.fugate@kctcs.edu