High Performance Vision Consulting Registration Form

"ALL YOU NEED TO KNOW ABOUT SPORTS VISION!"
The Registration Fee ($7,500) can be made by check at the address below.
PLEASE COMPLETE, PRINT AND SEND THIS FORM WITH YOUR CHECK.

Once received Dr. Teig will contact you to setup your appointment for your virtual course.

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: