Your interests (please check all that apply):    

Sales     Optician  Contact Lens Fitter   Optometrist    Medical Doctor    Lab Tech  

  Office/Clerk    Computers    Management  

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Are you a Certified Licensed Optician, Optometrist, M.D.?   Yes      No

List Provinces in which are you licensed:

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First Name:    Last Name:

Street Address:      Apt:    City:   

Province:   Postal Code:   Phone: Phone:   

E-Mail: 

List languages spoken and any additional information, comments or questions:

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