Report Results

After you've "lifted spirits" by collecting good time on Sight Night, let us know how you did to receive your official Sight Night Certificate! Complete and submit this form by the end of November. * Indicates a required field. First Name:* Last Name:* Organization:* (Organization, group or company name. Lions clubs, please list your district.) Email Address:* Street Address:* (We cannot ship to P.O. boxes.) City:* State/Province:* AlabamaAlaskaAlberta American Samoa ArizonaArkansas British ColumbiaCalifornia Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Islands Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon TerritoryNot Available Country:* Zip Code/Postal Code:* Daytime Phone:* (with area code, e.g. 513-765-4321 no cell phones please!) Volunteers:* (Approximate Number) Number of Glasses Collected:* (must be able to verify results) Did you partner with a store? Lions Club?? NoneLensCraftersPearleVisionSears OpticalTarget OpticalBJ's OpticalSunglass Hut/Watch StationLions Club Tell Us How You Collected: Your Sight Night Stories: How many years have you participated in Sight Night? 1234567 In the future, would you download materials from our Web site instead of receiving a collection kit? YesNo If no, then why? How did you hear about Sight Night?*