BBF > Optometrist Registration Form..

Store Information..

Walmart Store#:

Profile Information..

Profile Type:	Doctor
Doctor Type:
First Name:
Last Name:
Office Phone:	--
Fax:	--
Email:
	Notify on Application Approval (available only by email)
Address:

BBF Information..

	I will donate 20 eye exams for the 2011-2012 school year
	I will donate 10 eye exams and provide 10 for a reduced fee of $25
	I will provide 20 eye exams at a reduced fee of $25

Thank you..

Thank you so much for participating in the "Eyes of a Champion" program in cooperation with the Brandon Burlsworth Foundation. Together, we are making a difference in the lives of many underprivileged children. The "Eyes of A Champion" main goal is to help the lower middle class families who do not qualify for any other government programs. We strive to help those who are striving to help themselves.

We receive heartbreaking requests daily for exams and glasses and are proud to partner with you to provide vision services for these truly needy students preschool through 12th grade.

Registration Tip..

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