SouthEastern Opticians Conference
Thirteenth Annual Conference: July 22 - July 25, 2011
Conference Registration
Please print this form and mail to:
P.O. Box 907473
Gainesville, GA 30501
Total
Name:
Address:
Phone:
E-mail:
Method of Payment
This credit card information may be sent to an unsecured site and may be visible to others.
Exp. date:
Early Bird rates good until July 10. 2011.
You may also print and fax this form to 770-297-0678.
Non Member Early Bird
Member Early Bird
$300.00
$250.00
$199.00
$150.00
$ 75.00
$100.00
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