MainTECHNICIAN PROGRAM REGISTRATION(Please complete the form below) Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.REGISTER: *Technician Program - $195.00Luncheon - $55.00Luncheon is included in the Technician Program registration fee. Payment is required if you wish to add an additional lunch.Attendee Name *FirstLastAttendee Email *PAYMENT DETAILS Total$0.00I will pay by:Credit CardWills Eye PO#To pay by check: Send payment to: Wills Eye Alumni Society 840 Walnut Street, 8th Floor Philadelphia, PA 19107 Credit Card Information *We accept Visa, Mastercard, American Express, and Discover.Service/Practice: *Company/Organization/Practice NameContact Name *FirstLastContact Email *Contact Phone: *Questions about registration? Please contact Susan Umfer, sumfer@willseye.org SUBMIT
