Affiliate Host Interest and Commitment Form

Thank you for your interest in hosting an ACB-Meta Smart Glasses Distribution Event for Blind Veterans.

Through ACB’s partnership with Meta, participating affiliates and chapters will have an opportunity to bring Meta smart glasses directly to eligible blind veterans in their communities.

ACB will provide participating organizations with centralized participant registration, promotional and outreach materials, an event toolkit, training resources, and program guidance. Meta will provide the glasses and ship them to an approved location identified by the participating organization.

Local organizations will be responsible for planning and carrying out their distribution event, including local outreach, venue arrangements, volunteers, participant communication, eligibility verification, distribution, and basic setup assistance.

Please submit your interest by Sunday, August 23.

Phone

This field is for validation purposes and should be left unchanged.

Organization Information

Tell us who is submitting this interest form and how to reach you.

ACB affiliate or chapter name(Required)

City and state(Required)

For example: Coos Bay, Oregon

Primary event coordinator(Required)

The person who will lead planning for this event.

Email address(Required)

Phone number(Required)

Your Proposed Event

Share your best estimate. Details can be adjusted later with ACB.

Proposed event date(Required)

Month

Day

Year

Enter the month, day, and year in the three boxes.

Event location or venue name(Required)

Event address(Required)

Street Address Address Line 2 City State ZIP Code

Approximately how many blind veterans do you believe your organization could serve at this event?(Required)

Please enter a number greater than or equal to 0.

Enter a whole number.

Approximately how many pairs of glasses are you requesting?(Required)

Please enter a number greater than or equal to 0.

Enter a whole number.

Receiving the Glasses

Meta will ship glasses directly to an approved location designated for your event.

Name of person responsible for receiving the shipment(Required)

Shipping address(Required)

Street Address Address Line 2 City State ZIP Code

This is where Meta will send the glasses. It does not have to be the event venue.

Phone number for shipping contact(Required)

Can someone at this location securely receive and store the glasses until the event?(Required)

Yes

I need more information

Event Volunteers and Support

Can your organization provide volunteers to assist with check-in, eligibility verification, distribution, and basic glasses and smartphone setup?(Required)

Yes

Unsure, we would like to discuss this with ACB

Approximately how many volunteers do you anticipate having available?(Required)

Please enter a number greater than or equal to 0.

Enter a whole number. An estimate is fine.

Reaching Blind Veterans

An important goal of this initiative is reaching blind veterans in the community, including those who may not currently be connected with ACB.

How does your organization plan to reach blind veterans in your area?(Required)

Local VA facilities or programs

Veterans Service Organizations

VFW

American Legion

Lions Clubs

State or local blindness organizations

Vocational rehabilitation or other blindness agencies

Local media or community calendars

Social media

Our existing affiliate or chapter network

Other

Check all that apply.

If you selected Other, please describe it here

Leave this blank if it does not apply.

Please briefly tell us about any existing relationships or outreach opportunities that may help you reach blind veterans.

Optional.

Host Commitment

By submitting this form, our organization understands that ACB will provide the national program structure, centralized participant registration, promotional resources, training resources, and general program guidance.

Our organization will be responsible for local venue arrangements, volunteers, local outreach, participant communication, eligibility verification, on-site distribution, basic setup assistance, and completion of a brief post-event report.

We understand that submission of this form does not guarantee an allocation of glasses. Participation and the number of glasses available for each event are subject to final coordination with ACB and Meta.

Our organization is prepared to meet these host responsibilities.(Required)

Yes

We have questions we need to discuss with ACB before making a final commitment.

Name of person submitting this form(Required)

Role with affiliate or chapter(Required)

Anything else you would like ACB to know or any questions you still have?

Optional.

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