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REGISTRATION FORMBridging the Gap Between Children & Adults in Vision ServicesThis One-Day Conference will be held on Saturday, March 11th, 2017, from 9:00am to 4:00pm at the following location: Center for the Visually Impaired739 West Peachtree St. NW Atlanta, GA 30308Name: Phone Number: Address: AER Member #: Email address: Boxed lunch and drinks included with registration. Please indicate your choice by placing an X in front of the appropriate option below. Soft drinks, tea and coffee will also be available. Mediterranean Veggie Sandwich Smoked Turkey Sandwich Smoked Ham & Swiss Sandwich Classic Salad with balsamic vinaigrette dressing Greek Salad with herb vinaigrette dressing Caesar Salad with Caesar salad dressing ___ w Croutons ___ w/o Croutons - gluten free*all salads gluten free except Caesar salad; please indicate with or without croutonsIf alternative format required for conference materials, please indicate: (Braille or Electronic):Please complete and send back this registration form as soon as possible, either via email or mail to physical address below. The registration fee can either be mailed in as check or money order, or it can be paid at the door. Exact change required. Check or money order also accepted at door. Email Address for registration: lmwilliams1951@gmail.com Physical Mailing Address for registration: Linda Williams1208 Valley Drive NE Conyers, GA 30012-4632 |
