City & Country Serving: (required)
Mission Dates: (required)
Glasses Delivery Date (required):
Do you want sunglasses in your glasses pack?:
Handheld autorefractor loaner requested*:
U.S. Delivery Street Address: (required)
Is the shipping address a residential one?
If this is shipping to a business address, what is the name of the business?:
Name of Your Organization:
Are you a non-profit?
This is a VOSH MissionThis is a SVOSH MissionOther
Special Requests or Questions
* You will receive your handheld autorefractor 1-2 weeks before you depart for your mission trip and must send the handheld autorefractor back to National Vision the week you return. This is to ensure that NVI is able to maximize accommodation of requests.
In return for the items NVI donates/loans to your trip, we request that you share stories, photos and data (# of patients seen, # of glasses distributed, etc.) with us upon your return.
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