REGISTER FOR LASER VISION CORRECTION EDUCATIONAL SEMINAR

TO REGISTER FOR our laser vision correction free educational seminar please complete the following. We will contact you with a confirmation of the date, time and location. PLEASE DO NOT 'JUST SHOW UP' for these seminar. Our space is strictly limited and is open by invitation only. While we are delighted to have you as our guest, we do need to plan in advance! If you prefer, you may with to contact us by phone during regular office hours, Monday through Friday AT 516-466-8989.

OUR NEXT LASER VISION CORRECTION SEMINAR IS ON:

THURSDAY EVENING, DECEMBER 16TH AT 6:15 PM

Please provide the following contact information:

*First Name

*Last name

*Street address

Address (cont.)

*City

*State/Province

*Zip/Postal code

Country

*Work Phone

*Home Phone

FAX

*E-mail

URL

*Date of birth

*Sex . Male Female

* indicates required field

Please register me for the seminar date listed below:(you can also list comments, questions or request additional information:

How do you wish us to send you this informationt?:

e-mail  call me at work     call me at home     fax (US only)    U.S. Mail

How did you find our web site:

*First Name
*Last name


*Street address
Address (cont.)
*City
*State/Province
*Zip/Postal code
Country
*Work Phone
*Home Phone
FAX
*E-mail
URL

REGISTER FOR LASER VISION CORRECTION EDUCATIONAL SEMINAR

. Last revised: October 20, 2001

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Last revised: October 20, 2001