Click here for a printable version of the registration form
Registration
NROC Annual Conference - - July 19 – 21, 2012 - - Jackson Hole, WY
Registration includes Continuing Education, Exhibit Hall Pass, Lunch, Breaks and Breakfast.
Doctor Registration Information:
NROC Member Registration (Doctors belonging to either MT, ID or WY Associations)
Doctor Name : ______________________________________________________
Office Address :_____________________________________________________
Street:________________________ City___________ State____ Zip__________
Office phone :______________________ Home phone : ___________________
Doctor Registration
______ $430 Early registration. (Must be received by July 1)
______ $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 #_______
NROC Non-Member Registration
(Doctors not belonging to MT, ID or WY associations or the AOA)
_____ $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 19 and 20 Guest exhibit hall reception pass.
No one will be admitted to the exhibit hall without a badge or guest pass.
(Children under 5 free )
$_____ 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 20 Exhibit Hall Reception Pass Only necessary for non-registered persons.
$______ Total Paraoptometric Registration
$_______ Total all registrations (Doctor & Paraoptometric). Please make check payable to: NROC, P.O. Box 1967, Cheyenne, WY 82003
Click here for a printable version of the registration form
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