Registration - Eye Education Foundation

Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

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**If you attend less than 10 hours of lecture, your fee will be based upon a rate of $54.50 per hour of attendance. If you attend 10 or more hours, the fee will be $545.00

Gala Registration:
Roaring 20's Dothan Country Club

I will attend the gala*

Yes
No

My guest will be attending the gala*

Yes
No

If yes, Guest's Name:*

Dietary Restrictions:

Vegetarian
Gluten-Free
Vegan

Spouse/Guest Brunch or Golf Registration

My spouse/guest will attend spa.
My spouse/guest will attend golf.

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Interested in a T-Shirt?

Yes

There will be an additional charge of $20.

**If you prefer to mail your registration in, click here to download this form
Please mail back to:
Eye Education Foundation, Attn: Katie Woodham
2800 Ross Clark Circle, Ste 1, Dothan, AL 36301

Registration Fee

2020 : THE YEAR
OF VISION

2022 Speaker Interest

2020 : THE YEAR OF VISION

2022 Speaker Interest

2020 : THE YEAR
OF VISION