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Get USTA Officials Vision Examination Form 2018-2024

S of the exam, a physician's or optometrist's statement attesting that the Official has 20/20 vision either corrected or uncorrected in each eye. Name of Official (print) USTA Member Number Address (Print) I hereby state that the data contained herein is a true and accurate record and personally attest to a 20/20 vision, corrected or uncorrected in each eye. Health Care Provider's Signature Health Care Provider's Name I hereby give my consent that this information may be forwarded to the US.

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