REGISTRATION FORM
Florida Board of Optometry Examination Review Course
June 21 - July 22, 2008
____________________________________
NAME
____________________________________
ADDRESS
____________________________________
CITY
____________________________________
STATE
____________________________________
ZIP
____________________________________
TELEPHONE
____________________________________
E-MAIL (required)
$500 Graduate
Optometrist
$250 Graduate Optometrist (NSU Alumnus)
I am an alumnus of the NSU College of Optometry
Class of _________
Please complete this registration form, attach a check payable to
NSU College of Optometry, and mail both to:
Lorena Lizausaba,
Coordinator
Office of Continuing Education & Alumni Affairs
College of Optometry
Nova Southeastern University
3200 South University Drive
Ft. Lauderdale, FL 33328