Para reservar una cita, debe completar el formulario de registro adjunto y llevarlo a uno de los siguientes lugares de entrega:

Domingo, 28 de Abril, 2019 (10:00 a.m. to 4:30 p.m.)

Ubicado en Finley Center 2060 W. College Avenue Santa Rosa, California

por email: [email protected]

Montgomery Village Lions Club 740 Coney Court Santa Rosa, CA 95409 California Homemakers Association 468 Yolanda Avenue, Suite 102 Santa Rosa, CA 95404 Catholic Charities 987 Airway Court Santa Rosa, CA 95403 Salvation Army 93 Stony Point Circle Santa Rosa, CA 95401

Servicios incluyen: • • • •

Consulto de doctor de ojos Examen de vision & Glaucoma Anteojos reciclados Otros Servicios

Numero de telefono : _______________

Lugares de Entrega:

Redwood Empire Food Bank 3990 Brickway Boulevard Santa Rosa, CA 95403 Bellevue Union Schools: • • • •

Bellevue Elementary School Kawana Elementary School Meadow View Elementary School Taylor Mountain Elementary School

Personas sin cita pueden estar disponibles y será atendido por orden de llegada.

Email: ___________________________ Cuantas Personas : _________________ Corte en linea punteada

Clinica de ojos

Nombre: _________________________

Hora preferido (marca uno): 10:00-10:30 10:30-11:00 11:00-11:30 11:30-12:00 12:00-12:30 12:30-1:00 1:00-1:30

1:30-2:00 2:00-2:30 2:30-3:00 3:00-3:30 3:30-4:00 3:30-4:00 4:00-4:30

Sponsored by Montgomery Village Lions Club (A 501(c)(3) Non-profit Organization)

Sunday, April 28, 2019 (10:00 a.m. to 4:30 p.m.)

Located at Finley Center 2060 W. College Avenue Santa Rosa, California

By email: [email protected]

Montgomery Village Lions Club 740 Coney Court Santa Rosa, CA 95409 California Homemakers Association 468 Yolanda Avenue, Suite 102 Santa Rosa, CA 95404

Salvation Army 93 Stony Point Circle Santa Rosa, CA 95401

• • • •

Eye Doctor Consultation Vision & Glaucoma Testing Recycled Eyeglasses Other Services

Phone Number: ___________________

Mail or drop off points:

Catholic Charities 987 Airway Court Santa Rosa, CA 95403

Services include:

Name: __________________________

Redwood Empire Food Bank 3990 Brickway Boulevard Santa Rosa, CA 95403 Bellevue Union Schools: • • • •

Bellevue Elementary School Kawana Elementary School Meadow View Elementary School Taylor Mountain Elementary School

Walk-in appointments may be available and will be done on a first come, first serve basis.

Email: ___________________________ Number of patients: _______________ Cut along dotted line

Eye Clinic

To reserve a time, you must complete the attached registration form and take it to one of the following locations:

Preferred Time (circle one): 10:00-10:30 10:30-11:00 11:00-11:30 11:30-12:00 12:00-12:30 12:30-1:00 1:00-1:30

1:30-2:00 2:00-2:30 2:30-3:00 3:00-3:30 3:30-4:00 3:30-4:00 4:00-4:30

Sponsored by Montgomery Village Lions Club (A 501(c)(3) Non-profit Organization)