"*" indicates required fields Δ FacebookThis field is for validation purposes and should be left unchanged.Organization InformationName of Eye Bank*Name of Organization's ContactContact's Job TitleContact's Email Address*Name of Executive DirectorDates when eye bank is unavailable to hostFacility InformationQuantity of event spacesHow many event spaces are available for use? Please include the types of rooms (Ex. Conference room, classroom, event space, etc)Classroom/Event Room Size:(Please include dimensions and square footage)Meal Space SizeMeal Space Size (If 2nd space is available)Slit LampsThe number of slit lamp microscopes that will be available to attendees/instructors. Please include the types of slit lamps if known.Number of CorneasHow many corneas and whole eyes will your organization be able to provide for evaluation during the seminar?A/V EquipmentList all A/V equipment that will be available during the event.Distance to airportList any notable restaurants/attractions within 3 miles of eye bankName(s) of nearby hotel(s)Include any contracted rates that they eye bank may have with a specific hotel.File UploadPlease upload any photos of event space/equipment, floor plans, and any additional documents that should accompany your proposal.File Upload Drop files here or Select files Accepted file types: doc, docx, pdf, jpg, , Max. file size: 25 MB. CAPTCHA
