How do I join?

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:_____________

____________________________________________________

**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