Prevent Blindness Ohio: Survey - Prevent Blindness Ohio Preschool Vision Screening Training Application

1.

Please provide your registration information.

*

Name:

Title	First Required	Middle Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	StateRequired	ZIPRequired

*

Phone Number: Required

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2.

Medical practice/business name

*3.

Please select a training location/date.

4.

Number attending:

Remember:

When filling out your application form or registering online, mark which training you will attend.
No CEU’s are offered.
No confirmation will be sent.
Access directions to training locations via http://www.mapquest.com/.
There is NO COST to attend the training.
Let Prevent Blindness Ohio know if you need to cancel/reschedule by calling 800.301.2020.

Note:

If you have a group of 15 or more that would like a separate training, please contact Prevent Blindness Ohio at 800.301.2020.