Registration

NROC Annual Conference - - July 22 – 24, 2010 - - Jackson Hole, WY

Doctor Name : ______________________________________________________

Office Address :_____________________________________________________

Street:________________________ City___________ State____ Zip__________

Office phone :______________________ Home phone : ___________________

Doctor Registration

______ $430 Early registration. (Must be received by July 1) Registration includes 17 hours CE, exhibit hall reception, lunch, breaks.

______ $470 Late registration. Postmarked after July 1 or on site registration.

I am a member of the Wyoming ___, Idaho ___, Montana ___ optometric association.

I am a member of the AOA ____ Member #_______

_____ $700 Non-member registration. Doctors who do not belong as dues paying members of either the AOA or the state optometric associations of Wyoming, Montana or Idaho.

_____ $30 July 22 Guest exhibit hall reception pass. No one will be admitted to the exhibit hall without a badge or guest pass.
(Children under 5 - no charge )

$_____ Total Doctor Registration

Paraoptometric Registration

Name/s __________________________________________________________________

Address ________________________ City ________________ St _____ Zip _________

$______ $190 Early Registration. Must be received by July 1. Included paraoptometric education, exhibit hall reception, lunch, breaks.

_______ $210 Late or at conference registration. (Received after July 1)

_______ $30 July 22 Exhibit Hall Reception Pass Only necessary for non-registered persons.

$______ Total Paraoptometric Registration

$_______ Total all registrations (Doctor & Paraoptometric). Please make check payable to: NROC, 716 Randall Avenue, Cheyenne, WY 82001

Sorry, NROC does not accept credit cards.

Click here to have a printable version of the registration form