Registration

Thank you for your interest in attending the Adult Vision Screening/Healthy Eyes Training  on Monday, November 5, 2018, 8:30 am to 12:30 pm. 
It will be held at the Columbus Medical Association offices at 1390 Dublin Road in Columbus, Ohio.
Please feel free to contact me if you have questions.

Thanks,
Stephanie Koscher 
800-301-2020 ext. 115
stephaniek@pbohio.org

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* 1. First Name

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* 2. Last Name

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* 3. E-Mail Address

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* 4. Phone Number

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* 5. Organization

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* 6. Job Title or Volunteer Role

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* 7. Street Address

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* 8. City

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* 9. State

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* 10. Zip code

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* 11. County

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

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