Contest Entry Form

First Name *

Last Name *

Practice Name

Address 2

City *

State *

Zip/Postal Code *

Email Address *

Terms & Conditions *

Applicant must be a resident of the United States or Canada and be a current Optometrist or Optometry Student. Upon entering the TN2B contest, you agree to complete the required training if you win the grand prize and subscribe to receive promotional offers and digital mail from Valley Contax. Entries close July 1st, 2022 and the winner will be announced July 6th, 2022. I have read and agree to the terms and conditions.