SEOC SouthEastern Opticians Conference
2009 Registration Form












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2009 SOUTHEASTERN OPTICIANS CONFERENCE REGISTRATION FORM
Please print this form and:
Mail to SouthEastern Opticians Conference, P.O. Box 907473, Gainesville, GA 30501
Or fax to 770-297-0678   
Name___________________________________________________________
Company________________________________________________________
Street Address________________________________________
City_________________ State_______ Zip________
Bus Ph_______________________ Hm Ph_________________________
Fax_______________________
E-mail ___________________________________________________________

 

Package
Price Description

Price

Amount
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Conference Only
Member Early Bird
$150.00
$
Registration
Non Member Early Bird
$199.00
$
Saturday and
Member
(After 7/10/09)
$225.00
$
Sunday
Non Member
(After 07/10/09)
$275.00
$

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Workshop Only
Early Bird
$150.00
$
Optical Olympics - Looking at the Optical Toolbox
Friday 9:00am - 4:00pm
Lunch on your own
After 07/10/09
$200.00
$
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Combination
Optical Olympics Workshop (6 Hours)
Member Early Bird

$250.00

$
plus Saturday and Sunday (11 Hours)
Non Member Early Bird

$300.00

$
       
 
Member After 07/10/09
$325.00
$
 
Non Member After 07/10/09
$375.00
$
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Please enter the total
amount owed for all requested
courses here.
$




























Please indicate the state society of which you are a member in good standing:





AL _____  FL _____  GA _____  KY _____ 
NC _____ SC _____  TN _____  VA _____   



























Payment Information:
Make check payable to SEOC or Credit Card:  ____AmX ____Visa____MC____Disc
Account #___________________________________   Exp. Date ___/___
Total: $_______________ 
Name As it appears on card (please print)  _____________________________ 
Signature_______________________________________________Date______________________________