On Line
Information Request 

Please complete the information below. Indicate if you would like more information or personal contact from one of our staff via E-mail, telephone or postal mail. Also, please feel free to leave comments below. Thank you for visiting our web page.
 
 
Full Name
Title
Organization
 
Address
City, State, Zip        
 
Phone
Fax
E-Mail Address
Comments
 
1. I would like the following information sent to me:
 
    Information on Eye Donation
 
Give the Gift of Sight donor card brochure
Corneal Transplantation and You (A Patient Reference)
"Eye Opener" Newsletter
"Life beyond Loss" Booklet
 
 
2. I have the following requests/questions that I would like have addressed
 
Schedule a Speaker for a Presentation to my Organization,
Church, Civic Group, etc.
Talk to Someone who has undergone a Corneal Transplant so that I can learn more about what to expect in surgery
Talk to the Branch office Coordinator/Manager about scheduling programs/inservices in my facility
Other    
 
3. I would like to hear from the Eye Foundation via (Please include this information above):
 
Phone
E-Mail
Post-Mail
FAX
 
 

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