Scientific Forum
Featuring the 2025 Prevent Blindness Ohio Vision Research Fellowship Recipients
Tuesday, November 18, 2025
1:00 pm to 2:00 pm
via Teams

Registration

Please complete the registration information below and click the "Done " button. You will receive a Zoom link one week before the Forum.

Question Title

1. Preferred Salutation

Ms.

Miss

Mrs.

Mr.

Dr.

none

Question Title

2. First Name

Question Title

3. Last Name

Question Title

4. Home Address

Street Address

Apt#

City

State

Zip Code

Ohio County

Question Title

5. Work phone number

Question Title

6. Home or Cell Phone number

Question Title

7. Preferred E-mail address (Required.)

Question Title

8. Job title, volunteer position, or student.

Question Title

9. Work Address

Organization

Address

City

State

Zip Code

Ohio County

Scientific Forum Featuring the 2025 Prevent Blindness Ohio Vision Research Fellowship Recipients Tuesday, November 18, 2025 1:00 pm to 2:00 pmvia Teams

Registration

Question Title

* 1. Preferred Salutation

Question Title

* 2. First Name

Question Title

* 3. Last Name

Question Title

* 4. Home Address

Question Title

* 5. Work phone number

Question Title

* 6. Home or Cell Phone number

Question Title

* 7. Preferred E-mail address (Required.)

Question Title

* 8. Job title, volunteer position, or student.

Question Title

* 9. Work Address

Question Title

* 10. Additional Comments

Scientific Forum
Featuring the 2025 Prevent Blindness Ohio Vision Research Fellowship Recipients
Tuesday, November 18, 2025
1:00 pm to 2:00 pm
via Teams

1. Preferred Salutation

2. First Name

3. Last Name

4. Home Address

5. Work phone number

6. Home or Cell Phone number

7. Preferred E-mail address (Required.)

8. Job title, volunteer position, or student.

9. Work Address

10. Additional Comments