High Performance Vision Consulting Registration Form

"ALL YOU NEED TO KNOW ABOUT SPORTS VISION!"
A non-refundable deposit of at least half the Registration Fee ($4,250) can be made by check at the address below. The remaining $4,250 is due by the start of the conference. Your registration will not be confirmed until a deposit of at least half of the registration fee is received.
PLEASE COMPLETE, PRINT AND SEND THIS FORM WITH YOUR CHECK.

Make checks payable to:
Dr. Don Teig

Ultimate Events, LLC

3111 North Ocean Drive, Suite 1212

Hollywood, FL 33019

Mobile: 203-312-3123 (call if any questions)
Registration Form

Please fill in the form below.
Full Name *
Prefix First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *
- Area Code Phone Number
E-mail *
Doctors Attending *
Additional Attendees
Names of Attendees
Comments
Registration Fee Included *
USD
Should be Empty: