Patient Registration Forms

On-Line Seminar Registration

Name:
Best Daytime Phone:
E-Mail:
Number of people attending:

I would like to attend a Seminar on:

  Cataract Seminar - Tuesday, April 15 – Naples, noon
  Cataracts - Tuesday, April 15 – Fort Myers, noon
  Lens Implant Seminar - Thursday, April 17 – Naples, 5:30 pm

  Cataract Seminar - Tuesday, May 13 – Naples, noon
  Cataract Seminar - Tuesday, May 13 – Fort Myers, noon
  LASIK Seminar - Tuesday, May 27 – Fort Myers, 5:30 pm
  LASIK Seminar - Thursday, May 29 – Naples, 5:30 pm