Legislative Day | California Optometric Association

LEGISLATIVE DAY ATTENDANCE FORM
Sheraton Grand Sacramento Hotel - Magnolia/Camellia Room

1230 J Street, Sacramento, CA
Tuesday, May 13, 2014
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

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.

First Name *

Last Name *

Title/Degrees: *

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

License #

School (If Student):

I will attend Legislative Day and thank my legislators for supporting optometry.

Yes

I wish to participate in the Adopt-a-Student program.(This program matches doctors and students for lobbying lawmakers together. COA will pair you up and notify you of your partner.)

Yes

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

Email address: *

Phone number:

Registration deadline is May 6, 2014.

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.