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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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