Home

Gender *

Team Contact Name: *

Zip *

Want to donate used eyeglasses?

Here are our drop off locations!

Parent/Guardian Name (N/A if individual requesting assistance is over 18) *

Gender *

State *

Thank you for contacting the Orange Lions Club regarding your need. We do our best to respond in a timely manner, however, we are a volunteer-based organization and sometimes responses will be take longer.

Number of Adults in Household *

Payment submitted via: *

Mail (PO Box 1572 Orange, TX 77631)

PayPal (orangelionsclub@gmail.com)

State *

Employer (enter 'student' if a minor) *

Vision Need *

Vision Exam

Glasses

Both

Other (please include specifics in next section)

Team Contact Name: *

Marital Status *

Married

Single

Widowed

Separated

Divorced

Common Law

Student

Other

Other Pertinent Information

Parent/Guardian Name (N/A if individual requesting assistance is over 18) *

City *

Phone Number *

Number of Other Dependents in Household *

Team Contact Name: *

Gender *

Household Monthly Income *

Other Pertinent Information

Number of Children in Household *

Street Address *

Apartment/Unit

Email: *

Full Legal Name of Individual Requesting Assistance: *

Parent/Guardian Name (N/A if individual requesting assistance is over 18) *

Team Contact Email: *

Check here to receive email updates

Email: *

I acknowledge, understand, and agree to the rules/guidelines above: *

Yes

City *

Phone Number *

Team Contact Phone Number: *

Full Legal Name of Individual Requesting Assistance: *

Payment submitted via: *

Mail (PO Box 1572 Orange, TX 77631)

PayPal (orangelionsclub@gmail.com)

Street Address *

How long have you lived in Orange County? *

Orange Lions Club

Number of Other Dependents in Household *

Phone Number *

I acknowledge, understand, and agree to the rules/guidelines above: *

Yes

I acknowledge, understand, and agree to the rules/guidelines above: *

Yes

Apartment/Unit

Type of Gumbo you are preparing: *

Chicken/Sausage

Seafood

Vision Need *

Vision Exam

Glasses

Both

Other (please include specifics in next section)

Zip *

Team Contact Phone Number: *

Gumbo Cookoff Team Name: *

City *

Employer (enter 'student' if a minor) *

I acknowledge, understand, and agree to the rules/guidelines above: *

Yes

Team Contact Email: *

Check here to receive email updates

Number of Children in Household *

How long have you lived in Orange County? *

Date of Birth *

Apartment/Unit

Gender

Male

Female

Payment submitted via: *

Mail (PO Box 1572 Orange, TX 77631)

PayPal (orangelionsclub@gmail.com)

Team Contact Email: *

Check here to receive email updates

Number of Adults in Household *

Phone Number *

State *

Other Pertinent Information

Any existing insurance coverage? *

Gender

Male

Female

Gumbo Cookoff Team Name: *

Apartment/Unit

Type of Gumbo you are preparing: *

Chicken/Sausage

Seafood

Number of Adults in Household *

Street Address *

Type of Gumbo you are preparing: *

Chicken/Sausage

Seafood

Number of Other Dependents in Household *

Zip *

Type of Employment

Full Time

Part Time

Team Contact Phone Number: *

Any existing insurance coverage? *

Vision Need *

Vision Exam

Glasses

Both

Other (please include specifics in next section)

Marital Status *

Married

Single

Widowed

Separated

Divorced

Common Law

Student

Other

Thank you for contacting the Orange Lions Club regarding your need. We do our best to respond in a timely manner, however, we are a volunteer-based organization and sometimes responses will be take longer.

Gender *

Type of Employment

Full Time

Part Time

Employer (enter 'student' if a minor) *

Number of Children in Household *

City *

Full Legal Name of Individual Requesting Assistance: *

Parent/Guardian Name (N/A if individual requesting assistance is over 18) *

Team Contact Email: *

Check here to receive email updates

Gender

Male

Female

How long have you lived in Orange County? *

Marital Status *

Married

Single

Widowed

Separated

Divorced

Common Law

Student

Other

Any questions?

Any existing insurance coverage? *

Type of Employment

Full Time

Part Time

Number of Children in Household *

Type of Gumbo you are preparing: *

Chicken/Sausage

Seafood

Other Pertinent Information

Email: *

A Little Bit Gaudy- located in Northway

American Real Estate-1304 N 16th St

Bridge City Bank-57 Strickland Dr

Dallas Insurance-1106 N 16th St

Innovative Air-2435 MLK Jr Dr

Mann Insurance-1505 W Park Ave

Sweet Bee Boutique- 2637 Texas Ave (Bridge City)

Cecil Motors

Zip *

Any existing insurance coverage? *

Vision Need *

Vision Exam

Glasses

Both

Other (please include specifics in next section)

Number of Adults in Household *

Date of Birth *

Thank you for contacting the Orange Lions Club regarding your need. We do our best to respond in a timely manner, however, we are a volunteer-based organization and sometimes responses will be take longer.

How long have you lived in Orange County? *

Thank you for contacting the Orange Lions Club regarding your need. We do our best to respond in a timely manner, however, we are a volunteer-based organization and sometimes responses will be take longer.

Any questions?

Marital Status *

Married

Single

Widowed

Separated

Divorced

Common Law

Student

Other

Payment submitted via: *

Mail (PO Box 1572 Orange, TX 77631)

PayPal (orangelionsclub@gmail.com)

Household Monthly Income *

Street Address *

Team Contact Phone Number: *

Full Legal Name of Individual Requesting Assistance: *

Any questions?

Team Contact Name: *

Number of Other Dependents in Household *

Date of Birth *

Employer (enter 'student' if a minor) *

Household Monthly Income *

Household Monthly Income *

Date of Birth *

Gumbo Cookoff Team Name: *

Any questions?

Gumbo Cookoff Team Name: *

Type of Employment

Full Time

Part Time

Gender

Male

Female

Email: *

State *

Home
About
Get Involved
The Carnival
Become a Lion!
Gumbo Cookoff
Mural Project
Vision Assistance

Home
About
Get Involved
The Carnival
Become a Lion!
Gumbo Cookoff
Mural Project
Vision Assistance

Copyright 2013. Orange Lions Club. All Rights Reserved.