Seeing the World - Illinois College of Optometry

Registration Form
Also available online at www.ico.edu/alumni/homecoming 2011.
Registration registration deadline is August 19th.
Early Bird Special!
Register register by July 30th 30 to to be be entered into into a drawing a drawing for for an an iPad iPad 2 2
Name name ___________________________________________________________________
Guest guest ___________________________________________________________________
Address __________________________________________________________________
(Circle (circle one: home/office)
City city ____________________________________________________________________
State state _________________ Zip________________________________________________
Phone ___________________________________________________________________
(Circle (circle one: home/office/cell)
Email email ___________________________________________________________________
Class class of __________________________________________________________________
FRIDAY, SEPTEMBER 9TH
___ Class class Reunion reunion and Alumni Awards Reception reception and Banquet banquet
$125.00 per person
___Yes, ___yes, I i would like child care services for _____ child(ren) for the evening.
(You (you will be contacted with details.)
OPPORTUNITY TO SPONSOR A STUDENT
___Yes, ___yes, I i would like to sponsor a student to attend the Class class Reunion/Awards reunion/Awards Banquet banquet on
September september 9th, by adding $125.00 per sponsored student to my total payment.
SATURDAY, SEPTEMBER 10TH
___Grand ___grand Opening of the Lecture Center center and Campus campus Tours tours
___Two ___two Hours hours of Continuing continuing Education education (non-tested)
$30.00 Alumni/$60.00 Non-Alumni
non-Alumni
___Student/Alumni ___student/Alumni Mingle mingle
Complimentary/No complimentary/no Charge charge
___Blindspot ___blindspot Carnival! carnival!
$25.00 (adult), $10.00 (12 yrs. and under), Free (2 yrs. and under)
Payment Options:
r Check check Enclosed: enclosed:
Please make check payable to Illinois illinois College college of Optometry.
r Check check Pending:
I i registered via fax and my check has been mailed.
r Credit credit Card: card:
Visa visa MasterCard mastercard Discover discover AmEx Amex
(Please indicate the number attending each event on the line provided.)
SUNDAY, SEPTEMBER 11TH
___Four Hours hours of Continuing continuing Education education (non-tested)
$60.00 Alumni/$120.00 Non-Alumni
non-Alumni
Donation to Alumni Association Scholarship Fund
___I ___i would like to include a donation to ICO icO to provide scholarship funding for
aspiring young doctors. $______ Amount
_______ TOTAL PAYMENT DUE
Registration Options:
Please submit your registration form with
payment by August 19th.
Register by Mail:
Illinois illinois College college of Optometry, Attn: Alumni Office
3241 S. s. Michigan michigan Avenue, Chicago, chicago, IL iL 60616
Register by Phone:
312-949-7080
Register by Fax:
312-949-7683
Register Online:
www.ico.edu/alumni/homecoming2011
NEW! CHICAGO EXPLORER PASS
This this year, ICO icO will be providing Chicago chicago Explorer explorer Passes at a group discounted rate. A Chicago chicago
Explorer explorer Pass enables you to choose 3 Chicago chicago attractions to visit at rates that will save you
at least 20% off the regular price. And, you don’t have to wait in lines once you arrive at your
chosen destination! The the Chicago chicago Explorer explorer Pass lets you have instant entrance to most attractions
with no long waits. Go go to www.smartdestinations.com for the list of attractions. No no need to
decide in advance which attractions you want to visit. Your your pass also includes restaurant and
shopping deals.
___Chicago ___chicago Explorer explorer Pass (can be used any days within a 30-day period)
$40.50 per person
Card card # ____________________________________________
Exp. exp. Date date __________________________________________
Signature signature __________________________________________
Date date ______________________________________________