CPD Event Registration - Optical Express Group

Optical Express CPD Event Registration

Name(Required)

First Last

Email Address(Required)

Phone Number(Required)

GOC Number(Required)

Please select the CPD Event you are attending

Day in the Life Programme

Date Qualified(Required)

Current Employer / Self Employed(Required)

Do you have any allergies or dietary requirements?(Required)

Are you interested in providing post cataract surgery check up on behalf of Optical Express for your referred patient?(Required)

Yes

Current Job Title(Required)

Practice Name(Required)

Practice Address(Required)

Street Address Address Line 2 City ZIP / Postal Code Country

Are you IP qualified?(Required)

Do you have higher qualifications in Glaucoma?(Required)

Do you have a higher qualification in Medical Retina?(Required)

I agree to be contacted via email to be informed about future Optical Express CPD events(Required)

Yes

Name

This field is for validation purposes and should be left unchanged.