MOA Convention & CE Forum Registration



November 23-24, 2002

Baltimore Convention Center

To register via mail or fax, complete and print out the registration form below and either mail fax it to:

MOA Headquarters
720 Light Street
Baltimore, MD 21230-3816
FAX: (410) 752-8295

Your Name:
First Name for Badge:
Spouse Name (if registering):
Home Address:
City/State/Zip:
Email Address:
Telephone:
Fax:

(On/before 11/08/02)
Early Bird

(After
11/08/02) Regular
Full Registration - Includes all functions, Saturday 8:00 a.m. through Sunday 4:00 p.m.
MOA/AOA Member
$275
$300
Other
$375
$400
CE Forum Only - Includes 12 hours of CE, Saturday and Sunday continental breakfast, and lunch.    
MOA/AOA Member
$225
$250
Other
$275
$300
CE Saturday Only - Includes 6 hours of Saturday CE, continental breakfast, and lunch.    
MOA/AOA Member
$120
$150
Other
$175
$200
CE Sunday Only - Includes 6 hours of Sunday CE, continental breakfast, and lunch.    
MOA/AOA Member
$125
$150
Other
$175
$200
Paraoptometric - Includes 3 hours of CE (9:00 a.m. - 12:00 p.m.), Sunday continental breakfast, and lunch.    
All
$65
$75
Awards Dinner    
All
$65
$75
     
Total Registration Fees:
   $

We accept checks, VISA, AmEx and MasterCard (You can either pay online using a credit card or print this form out and mail it with check or credit card information to:

MOA Headquarters
720 Light Street
Baltimore, MD 21230-3816

Charge to VISA MC AmEx
Card #:
Exp. Date:
Cardholder Name:

(Please note: This is not a secure site)

Cancellation Policy - Full refund if cancelled by November 8, 2002. $50 fee if cancelled November 9-19, 2002. No refund if cancelled after November 19, 2002. Cancellation requests must be received in writing.

720 Light Street, Baltimore, MD 21230
TEL: (410) 727-7800• FAX: (410) 752-8295
EMAIL: MOA@assnhqtrs.com