Below, you will find links to assist you in registration. The links may be used to print the appropriate form(s):
Symposium Invitation: (click on USA KISS Invitation): KISS Invite 2012.pdf
General Symposium Registration: Registration Form 2012.pdf
Presentation Registration: KISS Presentation Registration 2012.pdf
OETracker numbers for USA ODs may be found at https://www.arbo.org/oetracker/oelookup.php
Completed forms should be mailed to:
KISS
Dr. Jeffrey Kraskin
4600 Massachusetts Ave., NW
Washington, DC 20016-2362
USA
REGISTRATION FORM - - Please complete and return PROMPTLY
NAME: _______________________________________________ E-MAIL: ____________________
ADDRESS: ________________________________________________________________________
OETracker # (for USA OD CE credit): _____________ TELEPHONE #: ________________________
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CHECK BELOW:
□ PRESENTER - - $185 □ NON-PRESENTER - - $190 (Fees includes Saturday dinner & Sunday brunch)
□ RESIDENT or STUDENT -- FREE - Meals NOT included
MEAL TICKETS for guests, residents, or students:
SATURDAY DINNER - $35: ______________ (# of tickets)
SUNDAY BRUNCH ---- $45: ______________ (# of tickets)
MAIL TO: KISS c/o Dr. Jeffrey Kraskin - 4600 Massachusetts Ave, NW
Washington, DC 20016-2362 - USA
PLEASE NOTE:
* Registration fee is for ALL Optometrists
* Meal tickets will be available on site for guests, residents, and students.
* On-site registration will be available
PRESENTATION REGISTRATION FORM
Please complete this Presentation Registration Form and submit with your Meeting Registration Form no later than December 9, 2011. Presenters will be provided 30 minutes for their presentation followed by open discussion. Presenters are requested to provide a narrative - not just PowerPoint slides - of their presentation to be used in any official publication of the Symposium.
Presentation Registration Form is required to help meet many of the various state Optometry Board requirements for continuing education acceptance. Please send the completed form to the above address.
Presenter’s Name(s) and E-Mail Address:
Paper Title:
Brief Outline of Paper or Synopsis:
Request for audio/visual needs [if your request can note be met, you will be contacted ]:
(Please note - An LCD Projector for computer presentation will be provided. Use of your own
laptop is recommended, or send your completed PowerPoint slides in advance to
jlkraskin@rcn.com.
Brief Curriculum Vitae: