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NEW JERSEY APPLICATION WORKSHEET FOR VISION USA SERVICES Please Read Eligibility Requirements Before Completing Application Worksheet “ALL” PROGRAM ELIGIBILITY REQUIREMENTS MUST BE MET VISION USA PROGRAM ELIGIBILITY
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Document Date: 2015-03-11 15:02:47


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City

FLEMINGTON / /

Company

NJLERC Referral Agency Instructions VISION USA / The New Jersey Lions Eyeglass Recycling Center / VISION USA SERVICES / /

Country

United States / /

Currency

USD / /

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IndustryTerm

Online Vision / online application / transportation / ONLINE BY NJ CURE / government insurance / /

MusicGroup

Native / Indian / Yes / Alaska / /

Organization

International Association of Lions Clubs / Lion’s Club / ALL / Essilor Vision Foundation / Applicant Signature Date FOR QUICKER SERVICE / Lions Club / American Optometric Association / Medicare / /

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Position

President / Secretary / COORDINATOR / NJCURE COORDINATOR / Representative / Cure Coordinator / NJ Cure Coordinator / /

ProvinceOrState

New Jersey / /

URL

www.njlerc.org / www.aoa.org/visionusa / http /

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