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OD / Optometry Student Registration 2011 OAL Fall CE Conference "From Clinical Ophthalmic Optics to Advanced Ocular Disease: A Broad Spectrum Optometric Review" (Paras have a separate registration form.) Save time & postage...register online @ www.optla.org *NOTE: Spouse/Guest Passes are required for breakfasts & luncheon. Name badges, issued at registration, WILL BE REQUIRED for entry into ALL functions as well as proper CE credit! ___In accordance with the Americans with Disabilities Act, check here if you require special services to participate. Attach a written description of your needs and we will contact you. PLEASE CIRCLE ALL APPROPRIATE FEE(S) FOR WHICH YOU ARE REGISTERING: Registration Category OAL or AOA Non-Members Members Early* / Late** / On Site*** Early* / Late** / On Site*** *Early Registration: must be rec’d by 10-7-11 **Late Registration: must be rec’d by 10-21-11, Online registration closes 10-21-11 ***On Site: applies to all forms rec’d after 10-21-11 Doctor Full Program $399 / $449 / $499 $599 / $649 / $699 13 hr CE, both breakfasts & Saturday Luncheon Doctor Saturday Only $279 / $329 / $379 $429 / $479 / $529 8 hr CE, Saturday breakfast & Saturday Luncheon Doctor Sunday Only $179 / $229 / $279 $329 / $379 / $429 5 hr CE, Sunday breakfast Spouse / Guest Pass *any non OD accompanying a paid registrant $25 / $35 / $45 $45 / $55 / $65 Covers breakfasts & Saturday Luncheon Optometry Student: FREE REGISTRATION IF COMPLETED ONLINE! www.optla.org PLEASE TOTAL ALL FEES INCLUDED ON THIS FORM: $____________ PLEASE PRINT NEATLY: _____________________________________Doctor/Opt Student _________________________Spouse/Guest (if registering) _____________________________________ City, State (_______)______________________Phone # with Area Code e-mail:________________________________________@______________________________________________________ ODs__________________________________ License # /State _________________________________OE Tracker Number Optometry Students_______________________________________________________College____________ Yr Graduating For payments by credit card: Credit Card #_____________________________________________________________________ Exp. Date____________________ Name on card_______________________________________________________________ COMPLETE ALL INFORMATION & RETURN WITH CHECK OR CREDIT CARD INFO PAYABLE TO: OAL, 115B N 13TH, OAKDALE, LA. 71463. OR, FAX COMPLETED FORM WITH CREDIT CARD INFO TO (318)- 335-0677. FOR MORE INFORMATION CALL 888-388-0675. CANCELLATION POLICY: Fees will be returned with the exception of a $50 per person administrative charge if notification of cancellation is received prior to October 7, 2011. Thereafter, $75 per person will be assessed. ABSOLUTELY NO REFUNDS ONCE THE CONFERENCE HAS BEGUN! "From Clinical Ophthalmic Optics to Advanced Ocular Disease: A Broad Spectrum Optometric Review" OAL FALL EDUCATIONAL CONFERENCE October 29-30, 2011 (REVISED 7/24/11) 2301 North MacArthur Drive Alexandria, LA 71303 (318) 619-3300 ROOM RATES: $99.00 CUT OFF DATE: October 7, 2011 (FORMERLY HAMPTON INN) "A distinguished panel of speakers will present a fast-paced, 13-hour, clinically relevant review of optometric topics including: ophthalmic optics and ametropia, contact lenses, pediatrics, binocular vision, low vision, optic nerve/glaucoma, anterior segment disease, posterior segment disease, and peri-operative care. Attendees will receive detailed course handouts of all slides presented. This course serves as a great educational opportunity for those wishing to enhance their clinical knowledge in these areas, and is an excellent preparatory review for optometric board certification exams."
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