TriCounty CPR Registration Form
Event Timing: Thursday, October 13th 5PM-9PM
Event Address: Forte Ristorante 486 State Route 10 West, Randolph, NJ 07869
Contact us at (908) 283-2130 or dkohansby@gmail.com
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This is the registration form for the TriCounty Optometric Society October meeting for Adult CPR and AED recertification hosted by the American Red Cross. Please note date and time of the meeting is listed above. This will be a combination lecture and demonstration, so dress accordingly. Dinner is included with the meeting. Dinner starts at 5 PM with the training beginning at 6 PM. We have applied for 4 regular CE Credits. The cost of the meeting is:
NJSOP Members = $110
Non NJSOP Members = $150
Please make checks payable to "TCSOP" and mail to:
Valley Vision Care
attn: TCSOP
106 Quarry Road, Suite 110
Hamburg, NJ 07419

Please complete this registration form prior to Wednesday October 5th as we need to get a count into Red Cross. 
Name *
Email *
Phone Number *
NJ License #/OM Number *
Are you an NJSOP Member? *
Which Local Society do you regularly attend *
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