Your information

Thank you for your interest in participating in our study. Please fill out the following information. We will be contacting you shortly to schedule a time for you to come in. Please answer all questions.
Your name:

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Your name:

What is your field of study?

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What is your field of study?

What year are you in your studies?

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What year are you in your studies?

Do you wear glasses or contact lenses with either bifocal or progressive lenses?

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Do you wear glasses or contact lenses with either bifocal or progressive lenses?

Your contact information (email and/or telephone):

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Your contact information (email and/or telephone):

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