Indiana Optometry's Meeting (April 16 & 17, 2021) Stand-By List

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Indiana Optometry's Meeting is currently sold out due to spacing limitations to ensure public health. If you wish to be placed on the stand-by list should IOA receive a cancellation on or before 5:00 p.m. on April 15, please use this electronic form to inform us of your interest. The fees listed below are for your information only - You will not be charged by using this form. If an opening occurs and you are able to attend the seminar, please plan to pay the appropriate fee by check.

Full Name: *

Email Address: *

Street Address: *

City, State & Zip Code: *

Cell Phone:

Type of Registration Desired: *

IOA/AOA Member ($415.00)

IOA/AOA Non- Member ($540.00)

IOA/AOA Member Partial Practice ($350.00)

IOA/AOA Life/Retired Member ($225.00)

Full Time Faculty ($200.00)

2020 Graduate (IOA Member) ($200.00)

2019 Graduate (IOA Member) ($230.00)

2018 Graduate (IOA Member) ($260.00)

Optometry Support Staff (135.00)

Required

Do you plan to attend the Awards Luncheon? *

Yes

Undecided

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