Please provide your email address for important updates & developments at The Kansas City Free Eye Clinic!
*
indicates required
Name:
Email:
Comment:
Email Address
*
First Name
*
Last Name
*
Birthday
Month
/
Day
Phone Number
(
)
-
Optional
Zip Code
What Would You Like To Hear About?
Volunteer With Us (Check the box to be notified of volunteer opportunities)
Important News & Updates (Check the box to receive our monthly newsletter)
Events (Check the box to be notified of special events)
Special Event Interests (Deprecated)
Guess The Grape - Blind Wine Tasting
Murder Mystery Dinner
Hamburger Mary's Charity Bingo
Volunteers
Student Volunteer
Eye Doctors, Opticians, Techs, and Paras
Community Volunteer
I Am A(n)
Eye Doctor or Optician
Business or Sponsor Representative or Owner
Social Worker
Lion (Lions Club)
Community Partner
Preferred format
HTML
Plain-text
