Ophthalmologist Sign-Up Form

*Week of May 12th
   
Thank you for choosing to participate in the first ACVO National Service Dog Eye Examination Day! Your commitment will help ensure the success of this event. Over 100 ACVO Diplomates told us they were interested in partnering with the ACVO in this event. The public relations plan for this event should help increase recognition in the veterinary ophthalmology profession on both a national and local level. 
  
REGISTRATION AND PARTICIPATION
We hope to complete the registration process for veterinarian-participants by January 20, 2008. This will allow us to begin marketing your involvement in this program. We will send you more details in early February, including press kits and media information for your clinic (via email). You may choose to have your clinic participate for one partial day, one day, several days or for parts of an the entire week. It is your choice when to schedule these exams. We just ask that you follow directions regarding data collection to help with future promotion should this occur again in the future, more information to come.  
   
LOCAL EVENT
Please review this article by Dr. Bill Miller, PR Committee Chair, to see the results of the local event he hosted in December. This article also provides preliminary information regarding the national event.
Results of local event held in December
    
SPONSORSHIP AND VAF SUPPORT
There is a possibility for significant sponsor dollars being collected from this event. We will plan to donate all proceeds after direct expenses are paid to the Vision for Animals Foundation. Therefore by supporting this event, you will also be supporting the growth of the VAF and its grant programs. Thank you!
* Please note that you may hold your event any day you choose should you have a conflict on the 12th or that week. The overall event will be publicized for this day/week but we understand that you may have commitments at that time and wish to hold yours immediately prior or post dates. Please just clarify this with clients as they call in to book appointments.
     
PUBLIC CONTACT INFORMATION: This information will be listed for service dog owners/managers to contact your office to make an appointment. Please fill out the form completely and according to the information you wish the public to view. (PDF available here - print or type into the form)
First name   Last name
Company/Institution
Address, Line 1
Address, Line 2 if needed
City State Zip  
Country
Contact phone Fax (optional)
Email (optional, for public use)
Website URL (optional)
    
Email for future program information to be sent: (ACVO use only)
 

For office reference: 

Information will be made public once the program is publicized the end of January. You will be notified prior to the posting so as to ready your staff for handling appointments. If you choose to remove yourself from this program, please email the ACVO office as soon as possible so your information may be deleted promptly.