ACES/SEE ISLAND QUALITY SURGERY XX REGISTRATION FORM

Registration includes daily continental breakfast, meetings, coffee breaks, Ophthalmology with a Punch sessions, Welcome Reception, Luncheon, Cocktail Reception and one Gala Dinner ticket. Guest Registration fee includes Welcome Reception, continental breakfasts, luncheon, Cocktail Reception and one Gala Dinner ticket.

Participant

Name
(Please enter it as you want it to appear on your name badge)
Affiliation
Degree/Certification   

Contact Information

Address
City
State
Zip/Postal Code
Country
Phone Number 
 Fax Number
Email 
 
OPHTHALMOLOGISTS OPTOMETRISTS OTHER GUEST
ACES/SEE
Member		 Non-
Member		 SEE
Member		 Non-
Member		 Allied
Health		 Corporate
Representatives
Early Registration
By 10/15/05		 $800 $850 $495 $545 $350 $325 $125
Registration
After 10/15/05		 $875 $925 $545 $595 $395 $350 $125

Other Opportunities:

Breakfast with the Experts (6:30 - 7:30 a.m. / space is limited and sessions run concurrently; includes breakfast):

Sunday, February 19, 2006 - $50.00. Choose preferred Expert:

   Expert 1: tba

   Expert 2: tba

Monday, February 20, 2006 - $50.00. Choose preferred Expert:

   Expert 1: tba

   Expert 2: tba

Optional Activities:

Villa Sunset Dinner - $200/person — Number:
        Saturday, Feb. 18 - 7:00-11:00 p.m.

Golf at Mahogany Run - $210/person — Number of persons:
        Sunday, Feb. 19 - 2:00 p.m. shotgun start

Catamaran Sail & Snorkel - $105/person — Number of persons:
        Monday, Feb. 20 - 1:00-4:00 p.m.

Request for Housing at Marriott's Frenchman's Reef

Date in:   Date out:

Number of persons:    One king:    Two doubles:    

Run of House ($257):    Water view ($312):    

Smoking Preference: Non-smoking      Smoking

Refund Policy: Cancellations must be received on or before December 31, 2005 for a full refund; 50% refund for cancellations received between January 1 and January 20, 2006. No refund for “no shows” or for those canceling after January 20, 2006.