Venue: Specsavers Training Centre Swansea Date: 18 February 2016 Time: 6:00pm - 8:00pm Full Name: Practice Name: GOC Number (if applicable) Telephone Number Email Address (for organisational purposes only) Practice Address Occupation Contact Lens Optician Optometrist Dispensing Optician Store Owner Director Other How many years fitting experience do you have? None 1-3 years 4-6 years 7-10 years Over 10 years Are you presbyopic? Yes No Are you interested in trying multifocal contact lenses during the masterclass event? Yes No If you answered "yes" to the previous question, please enter your full spectacle prescription including reading add & dominant eye. How would you rate your confidence at multifocal contact lens fitting (1 is low and 10 is high) - Select -12345678910Not applicable What is your current rate of success in fitting multifocal lenses amongst your patients? - Select -10%20%30%40%50%60%70%80%90%100%Not applicable Dietary Requirements (leave blank if none) Leave this field blank