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