1. PERSONAL INFORMATION

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Email:

Date of Birth:
ex:01/01/08

Age:

2. RSVP FOR A LASIK SEMINAR

Next Available Date:
Saturday, May 31st,
10:00am
Wyndham Costa Mesa
3350 Avenue of the Arts
Costa Mesa, California 92626

YES!   I'd like to RSVP for this seminar.   Number of guests:
No thanks.

3. FREE VIP LASIK EXAM

Please select the day(s) that you prefer and a staff member will contact you to schedule an appointment.

Monday    Tuesday    Wednesday    Thursday    Friday

4. REQUEST MORE INFORMATION

Please mail me a CD-ROM or information packet.