ONLINE PAYMENT FORM
OMIG 2015 DUES / MEETING REGISTRATION / LUNCHEON / DONATIONS
Ocular Microbiology and Immunology Group (OMIG) 2015 Annual Meeting
Friday,
November
1
3
th, 201
5
at
Caesars Palace, Las Vegas
, Nevada.
Registration begins at 6:45 a.m.
Annual meeting begins at 7:30 a.m. until 11:30 a.m.
The business luncheon meeting will follow from 11:45 a.m. to 1:00 p.m.
PAYMENT OPTIONS:
$95 Annual Dues with Meeting Registration AND Business Luncheon
$60 Annual Dues with Meeting Registration
$60 Annual Dues Only (not attending Meeting)
$35 Business Luncheon Only
MAKE A PAYMENT
Registration:
Payment for (choose one):
Annual Dues with Meeting Registration AND Business Luncheon $95.00 USD
Annual Dues with Meeting Registration $60.00 USD
Annual Dues Only (not attending Meeting) $60.00 USD
Business Luncheon Only $35.00 USD
If attending the luncheon, do you have any dietary restrictions?
No
Yes
If yes, please indicate dietary restrictions.
For NAMETAG:
Attendee's Name and Degree(s)
Donations:
Please Choose One:
Private Donation
Industry Donation
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