Registration Form for 2009 Boston Symposium

The Boston Macular Degeneration Symposium

When:
Registration: 9:00-10:00 AM
Presentations: 10:00-Noon
Display of Low Vision Aids

Where:
Schepens Eye Research Institute
Starr Center, 185 Cambridge Street, 2nd Floor
Boston, MA 02114

will attend the symposium

Unfortunately, I/we cannot attend, but please send me/us information on Vision Research.

Where did you hear about the symposium?

Please fill in the blank spaces completely. A confirmation of your registration will be e-mailed to you.

Entries marked * are required.

Salutation:

*Name:

*Address:

*City:

*State:

*Zip Code:

*Telephone:

*E-Mail:

*Number of Guests:

Guest Names and Addresses:

Have you ever attended a Schepens' Symposia?
If yes, where?

Donations are welcome.

A confirmation will be returned to you via e-mail.

No confirmation cards will be mailed.