CK Demonstration Registration
Free Demonstration Registration Form

Please fill out this brief form to register for a free demonstration or to have our Near Vision CK coordinator contact you. Seminars and education sessions will be held at 3409 North Hullen Street, Metairie, LA, (504) 888-2600, near the Lakeside Shopping Center or 804 Heavens Dr. Suite 206, Mandeville, LA 70471 (504) 845-3400, across from Beau Chene.

Get Map To Metairie Location
Get Map To Mandeville Location


*Required Fields
First Name:

Last Name:

Address Line 1:

Address Line 2:

City: State: ZIP:

Phone 1: Phone 2:

Email: Age: