MainTECHNICIAN PROGRAM REGISTRATION Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2REGISTER: *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 *I will pay by:Credit CardCheckWills Eye PO#NextPAYMENT DETAILS Total$0.00To 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.Wills Eye Contact Name *FirstLastEmail *I am registering a Wills Eye Attendee from the following Service/Department/Practice *CPECCorneaGlaucomaNeuro-OphthalmologyOculoplasticsOncologyPathologyPediatricsRetinaBailey WeberKing of PrussiaPaoliRittenhouse/HarrisOtherIf Other, please specify the Wills Eye Department/Service/Practice *Upload PO# Drag & Drop Files, Choose Files to Upload Contact Name *FirstLastContact Email *Company/Organization/Practice NameQuestions about registration? Please contact Susan Umfer, sumfer@willseye.org SUBMIT
