Registration

Thank you for your interest in attending the Adult Vision Screening/Healthy Eyes Training on Tuesday, November 27, 2018, 12:30-4:00pm
Southern Village Branch of the Clark County Library. Please note to attend you must live or work in Clark County.
Please feel free to contact me if you have questions.

Thanks,
Laura Schwartz
800-301-2020 ext. 112
lauras@pbohio.org

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. E-Mail Address

Question Title

* 4. Phone Number

Question Title

* 5. Organization

Question Title

* 6. Job Title or Volunteer Role

Question Title

* 7. Street Address

Question Title

* 8. City

Question Title

* 9. State

Question Title

* 10. Zip code

Question Title

* 11. County

Question Title

* 12. I have attended Adult Vision Screening?HealthyEyes Training in the past.

T