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Registration

Please complete the registration information below and click the "Done " button. You will receive an e-mail with Zoom access information for the webinar  a week prior to the webinar. For further information, contact Lauras@pbohio.org. 

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* 1. Preferred Salutation

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* 2. First Name 

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* 3. Last Name

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* 4. Home Address

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* 5. Work phone number

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* 6. Home or Cell Phone number

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* 7. Preferred E-mail address

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

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* 9. Work Address

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* 10. Once you complete training, are you willing to be contacted to provide vision screenings in your area?

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* 11. Have you been certified as an adult vision screener by Prevent Blindness  in the past?

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* 12. If yes, are you taking this class to re-certify?

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* 13. If yes, do you have the near and distance charts as well as Registration/Risk Assessment Forms?

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* 14. Additional Comments

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