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

Prevent Blindness Ohio Preschool Vision Screening Training Application

1.

Please provide your registration information.

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Name:

Title	First Required	Middle Required	Last Required

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Email: Required

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Street 1: Required

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from Prevent Blindness America.

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2.

Question - Not Required - Medical practice/business name

Training Dates and Locations

Cincinnati:

10/26/10 from 10:00 am to 2:00 pm

Rapid Run Middle School

6345 Rapid Run Rd., Cincinnati, OH 45233

Cleveland:

11/2/10 from 1:00 pm to 5:00 pm

The Free Clinic of Greater Cleveland

12201 Euclid Ave., Cleveland, OH 44106

Columbus:

10/25/10 from 1:00 pm to 5:00 pm

Westerville Public Library

126 S. State St., Westerville, OH 43081

Dayton:

11/4/10 from 12:30 pm to 4:30 pm

South Community, Inc.

3095 Kettering Blvd., Dayton, OH 45439

Newark:

11/2/10 from 12:30 pm to 4:30 pm

The Works Museum

55 South First Street, Newark, OH 43058

Toledo:
11/5/10 from 9:30 am to 1:30 pm
Mercy College of Northwest Ohio
2221 Madison Avenue
Toledo, OH 43604

3.

Question - Not Required - Please select a training location/date.

4.

Question - Not Required - Number attending:

Remember:

A maximum of 3 individuals from each organization/agency/office may attend.
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.