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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
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