Registration 2022 – Portugal

Spaces 1 2 3 4

Attendee

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Last Name

First Name

Title Please Select Prof Dr Mr Ms Mrs Other

Gender Female
Male
Prefer not to respond

Employer

Department

Building

Street Address 1

Street Address 2

City

State/Province

Postal Code/Zip Code

Country none selected Afghanistan Albania Algeria American Samoa Andorra Angola Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Côte D'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Costa Rica Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar(Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Réunion Sào Tomé And Príncipe Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu US Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wales Yemen Zambia Zimbabwe

Email 1 *

Email

Phone 1

Type Work
Mobile
Home

Phone 2

Type Work
Mobile
Home

Phone 3

Type Work
Mobile
Home

Dietary Restrictions

Attendee Type

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Attendee Type ISCLR Member
Non-Member

ISCLR Member Type Select ... Member Member & Council Member & Executive Member & Life/Emeritus

Do you also work for Industry? Yes
No

Which company? Select ... Alcon CooperVision Gelest Johnson & Johnson Vision Menicon Ophtecs Seed Shin-Etsu Silicones Other

Non-Member Type Select ... Corporate Advisory Board Member Industry Delegate Student Prospective Member Keynote Speaker Administrative

Which Company? Select ... Alcon CooperVision Gelest Johnson & Johnson Vision Menicon Ophtecs Seed Shin-Etsu Silicones Other

Which Company? Select ... Alcon CooperVision Gelest Johnson & Johnson Vision Menicon Ophtecs Seed Shin-Etsu Silicones Other

Which ISCLR member is sponsoring you?

Which ISCLR member is sponsoring you?

Meetings & Social Events

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Executive Meeting

Sunday, August 21st from 11:00 am - 1:00 pm

Student Meeting

Sunday, August 21st from 2:00 pm - 3:00 pm

Council Meeting

Sunday, August 21st from 3:30 pm - 4:30 pm

Moderator Meeting

Sunday, August 21st from 4:30 pm - 5:00 pm

Welcome Reception

Sunday, August 21st from 6:30 pm - 8:30 pm

Accompanying Person(s) Attending (no cost): Select ... 0 1 2 3

ISCLR Members Meeting

Monday, August 22nd - from 2:30 pm - 3:00 pm

Corporate Advisory Board, Industry, Keynote Speaker & Executive Dinner

Tuesday, August 23rd from 6:30 pm - 10:00 pm

Accompanying Person Attending (Cost $125 USD): Select ... 0 1

How to Pay for Accompanying Person Select ... Invoice to be sent Deduct from stipend

Gala Dinner

Thursday, August 25th from 7:00 pm - 10:00 pm

Accompanying Person Attending (Cost $125 USD): Select ... 0 1

How to Pay for Accompanying Person: Select ... Invoice to be sent Deduct from stipend

Corporate Advisory Board/Industry Breakfast

Friday, August 26th from 8:00 am - 9:00 am

Conference Attendance

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Which Sessions will you Attend? All Sessions
Partial Sessions

Select Sessions Monday Morning
Monday Afternoon
Tuesday Morning
Tuesday Afternoon
Thursday Morning
Thursday Afternoon
Friday Morning

Emergency Contact

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Last Name

First Name

Relationship to Attendee

Phone

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