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About NCLSA Vision Screening Awards Brochure
Our Mission
Guided by our commitment to clinical excellence, compassionate service and innovative outreach, we provide access to critical eye care and support – ensuring individuals and families across Northern California, they can see a brighter future!
About us 
The Northern California Lions Sight Association, Inc. (NCLSA), is an IRS 501(c)3 non-profit corporation whose membership represents Lions Clubs in Lions District 4-C5.
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As a local community service organization, NCLSA’s mission is to meet the vision-related service needs of Lions District 4-C5 residents through medical services, education and by use of available resources.
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Within this scope, NCLSA is committed to assuming the leadership role in improving and maintaining the eye health status of the residents and by identifying and assessing the community vision-related health needs.
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NCLSA accepts the responsibility of being the premiere charitable and community service organization, to provide dignity and to bring hope to the visually impaired who are medical underserved members of Yolo, Sacramento, El Dorado, Nevada and Placer counties and their surrounding areas and by providing financial assistance to help provide blindness and regain sight.
Patient Referral Form
Vision Screening 
This is our mobile Vision Screening vehicle and is used for Glaucoma and Vison Screening services. We provide a driver and our completely equipped van. Lions Clubs may reserve this unit by completing the reservation form and paying a usage fee.
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The club is responsible for obtaining an Optometrist to perform the vision screening.
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Usage fees are $0 for VIP Members, $150 for non-VIP members, and $25 for each Plus Optix and/or TITMUS screening device.
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The cost is due with the van reservation form. If the screening device is needed for more than one day, the cost is an additional $50 per day. The fees paid cover insurance, gas and maintenance costs. VIP Clubs may reserve the Sight Van and vision screening devices 12 months ahead of use.
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The email address on the form is incorrect and it will be updated shortly. Here is the correct email. ptalionsldy@gmail.com
Vision Van and Screener Reservation Form
Child Vision Screening Consent Form
Recommendations for a Successful Vision Screening
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Determine a date, time and location for your screening. Give yourself enough time to plan properly.
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Reserve the van as soon as possible.
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Set aside 6-8 hours for the event. Remember, location is everything.
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Hold your event somewhere with a lot of foot traffic (shopping centers, health fairs, culture festivals, etc.)
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If necessary, make sure that you have received the appropriate permission to park the van at your location. The van is 37’ long and 9’ wide, including the side mirrors.
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Secure the services of at least two Optometrists or Ophthalmologists. The more advance notice you give the better your chance of securing their services.
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At present, we have a CT-80 Computerized Tonometer, a TITMUS 2A reader on board with a hand-held Tonometer and Plus Optix device. The doctor’s must provide their own solution.
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On the day of the event, make sure you have 3-4 Lions always present to adequately staff the entire day. They will help with registration, assisting the doctors, etc.
Awards & Donations 
The funds that allow NCLSA to sponsor individual’s eyesight needs in our Community are generated by the interest from Trust Funds. These Trust Funds are, in large part, funded by the awards shown on this page.
Please support NCLSA by purchasing these awards for your Club Members, Business Associates and Friends. There are different levels and prices to consider. NCLSA Awards not only make your recipient’s feel special, they help to fund future eye-related surgeries, and can be purchased with community funds. View our awards table at next Cabinet Meeting.
Fill out the NCLSA Awards Order Form and mail to address on the form.
PDF NCLSA_Awards Order Form
Word Docx NCLSA_Awards Order Form
To fill out the form, use the item numbers from the graphic below.
Awards Chair
Director Lion Helene Smith
530-367-6583
Please write checks payable to
NCLSA
Mail To:
NCLSA – Awards
Lion Helene Smith
6583 Green Leaf Lane
Foresthill, CA 95631
Brochure 
NCLSA Brochure Sept 2025








