Members :: Student Section :: Student Application :: California Optometric Association

Keyperson Day Attendance Form

KEYPERSON DAY ATTENDANCE FORM Sacramento Convention Center, Room 202 1400 J Street, Sacramento, CA Wednesday, March 24, 2010 from 8:30 am to 5:00 pm After filling out the form, please print out a copy for your records, then click the "Submit Form" button.

IMPORTANT: YOU MUST SIGN IN AT REGISTRATION TABLE TO RECEIVE REIMBURSEMENT.

Name:

Nickname (If Desired):

Title/Degree(s):

( If Student)School:

Society:

Home Address (required to determine your legislative districts):

I will attend KP Day and thank my legislator for supporting the practice of optometry:
Yes
No

Please select an entree:

Southwest Grilled Steak Sandwich:
Grilled steak with avocado, caramelized onions, oven roasted tomatoes and chipotle aioli on a sourdough roll.

Roasted Turkey Sandwich:
Roasted turkey, pepper jack cheese, romaine, tomato, garlic aioli on a nine grain roll.

Black Forest Ham Sandwich:
Black forest ham with grilled portabella, swiss cheese, spring mix and whole grain mustard on a nine grain roll.

Vegetarian:

Chicken Caesar Salad: