Presented by SSWUG.ORG/vConferenceOnline	866-444-9495 or 520-760-2400
6420 E. Broadway Blvd., Suite A300	Fax: 520-284-9595
Tucson, AZ 85710	Fed ID 86-0946205

Pro Forma Invoice for Seeing is Believing 2013 

Your registration includes: On-demand viewing for one month following the event Access to the virtual live presentations and exhibitors Live, interactive chat with other attendees, speakers and sponsors

Don't attend SiB hungry! Order Domino's pizza for you and your staff

ECP01

Participate in SiB Focus Groups

ECP01

Participate with your entire staff

ECP01

Enter our SiB Photo contest - "The Look of Optometry Today"

ECP01

Is Your Practice Seeking an Optometrist?

ECP01

Registration: Seeing is Believing 2013	_______ $99.00
Don't attend SiB hungry! Order Domino's pizza for you and your staff	_______ $31.00
Participate in SiB Focus Groups	_______ $0.00
Participate with your entire staff	_______ $219.00
Enter our SiB Photo contest - "The Look of Optometry Today"	_______ $0.00
Is Your Practice Seeking an Optometrist?	_______ $0.00
TOTAL AMOUNT REQUESTED	_______________

*credit card required for processing payment, charge will be processed as vconferenceonline.com. Access to video training will be available immediately upon processing payment.

Requested By ___________________________________________ Date _____________________

Approved By  ___________________________________________ Date _____________________

Notes		Payment Information
		Name on card:
		Credit card number:
		Billing zip/postal code:
		Expiration date: ______/______/______ (mm/dd/yyyy)
		Signature: