Date:______________       Signature:______________________

EnvisionMembership Form

New Member*          SemesterRenewal** 

Name:____________________________       W______________

Address:_____________________________________________

Address Line 2:________________________________________

Phone:______________    E-mail:________________________

Major:__________________Fr             So              Ju            Se

Projected start date for optometryschool:___________________

Reasons for interest in optometry/joining theclub:_____________

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*New membership fee will be posted on website http://www.weber.edu/pre-optometry/Joining.html

**Renewal fee will be less than first time membership feedue to already purchasing a club t-shirt

First Time Membership Fee: tba

Renewal Fee: tba

-Membership must be renewed every semester
-Membership forms can be turned in to Susan Himelright in SL229,
to any of the presidency members (contact info
on Envision home page), or at any club meetings

Weber State UniversityOgden, Utah 84408

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