Venue: Lawrence and Harris Opticians, Hillside, 93 Cardiff Rd, Caerphilly, Mid Glamorgan CF83 1FQ Date: 17 December 2015 Time: 5:30pm – 8:30pm 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