Legislative Day

Fields marked with * are required.

LEGISLATIVE DAY ATTENDANCE FORM
Sheraton Grand Sacramento Hotel - Magnolia Room

1230 J Street, Sacramento, CA
Wednesday, February 27, 2013
7:30 am – Continental Breakfast
8:30 am – Opening Remarks and Program
4:30 pm – Anticipated End Time
(Across from the Sacramento Convention Center)
CONTACT: Kara Corches
Direct: 916-266-5026 or kcorches@coavision.org

You will receive an email confirmation after completing this form.

Registration form

Note: Students must identify their school in the field below and sign in at the registration table to be eligible to receive travel stipend.  

Name (First & Last):^*

Title/Degrees:^*

Society (If student, write "student"):^*

License #

School (If Student):

I will attend Legislative Day and thank my legislators for supporting optometry.^* Yes No

I wish to participate in the Adopt a Student program.^* Yes No

Home Address (required to identify your legislative district):^*

Email address:^*

Phone number:

Registration deadline is February 20, 2013.

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