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43rd Annual Resident and Alumni Day

Saturday, June 10, 2023

The Annual Resident & Alumni Day is scheduled for Saturday, June 10, 2023 in-person. It will be held at the T. Boone Pickens Biomedical Building in the NG3.112 Auditorium. You and a guest are also invited to attend the evening awards dinner in this celebration of the outstanding accomplishments of our departing Residents and Fellows.

Our distinguished guest speaker for this event is Russell N. Van Gelder, MD, PhD. He is Professor and Chair of Ophthalmology and the Director of the Roger and Angie Karalis Johnson Retina Center in Seattle. We also have Sidney Gicheru, MD as our Distinguished Alumnus Recipient this year. He is Founder of the LaserCare Eye Center in the Dallas/Fort Worth Metroplex.

If you would like to attend, please complete the registration form below by May 31st.

*A valid email must be provided

Thank you!

INTERNAL USE ONLY: Has this payment been confirmed? ______

For the confirmation email: If they asked any questions you want to answer in this email, you can put your reply here and it'll be included. You can also leave this field blank, the letter will be complete without it.

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For the reminder email: If they asked any questions you want to answer in this email, you can put your reply here and it'll be included. You can also leave this field blank, the letter will be complete without it.

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Great! I'll send them an invoice for you. Hit the little calendar "today" to enter today's date (for the invoice date).

M-D-Y

Punch in the amount to invoice (no dollar sign), and hit "Save and Stay" or "Save and Exit" on the form. For this record, it'll be ______ ______

I will attend

Seminar and Awards Dinner

Seminar Only

Awards Dinner Only

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Title
_*Required

First Name
_*Required

* must provide value

Last Name
_*Required

* must provide value

Degree
_*Required

Organization

E-mail
_*Required

* must provide value

Indicate Credit Desired
_{Please select all that apply}
_*Required

* must provide value

AMA/CME

OD CE Credit

Attendance Credit Only

No Credit Desired

TX OD License
_{*Required for OD's ONLY}

ADA Statement

Please check this box if you require assistance because of a disability to make this program accessible to you. Someone from our office will be in touch with you.

Are you a UT Southwestern Alumni or AlumnEye Association Member?
_*Required

Yes

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Registration Fee
Please Note: Refunds will only be issued if registration is cancelled 7 days before the event or earlier.
_*Required

$100 Seminar and Awards Dinner

$60 Seminar Only

$40 Awards Dinner Only

You are attending as a critiquer/judge/awardee

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Registration Fee
Please Note: Refunds will only be issued if registration is cancelled 7 days before the event or earlier.
_*Required

$125 Seminar and Awards Dinner

$85 Seminar Only

$40 Awards Dinner Only

You are attending as a critiquer/judge/awardee

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Before continuing, please click here to pay your registration fee via our payment site (BluePay).

When you have completed your payment, please return to this form and click submit.

We invite you to bring one guest to our Awards Dinner
There is an additional $40 fee to bring a guest

Yes

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Before continuing, please click here to pay the guest fee via our payment site (BluePay).

When you have completed your payment, please return to this form and click submit.

Questions or Comments Before Meeting:

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