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Our Vision Programs
Request Our Vision Screening Services
Request Participation in a Health Fair or Community Event

To request Prevent Blindness Texas (PBT) participation in a health fair/community event, please complete this form and submit as directed below. Submission of this form DOES NOT guarantee PBT participation in your upcoming event. Participation is based on staff and/or volunteer availability and focus area of our programs. If PBT is able to attend your event, we will fax or email CONFIRMATION notice.

If you would like Prevent Blindness to conduct vision screenings at your event, please be prepared to provide the following:

  • 2 tables, 6-8 chairs
  • Small trash bin
  • Electrical outlet for 2 equipment items
  • Quiet indoor location (away from bright daylight)

Event Type (required)

Will refreshments be provided? (required)
yesno

This event is designed for which system? (required)

Estimated Attendance (required)

What population(s) will primarily be served at the event? (required)

What age range(s) will be served? (required)

Will an interpreter be available? (required)
yesno

In the event that a Prevent Blindness Texas representative is not able to attend your event, would your organization still like educational materials sent to the organization address? (required)
yesno