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Are you interested in trying contact lenses
FREE OF CHARGE?
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First Name:
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Last Name:
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E:mail address:
Do You Currently Wear Spectacles for Reading:
yes |
no
Do You Currently Wear Spectacles for Distance Vision:
yes |
no
Do You Currently Wear Contact Lenses:
yes |
no
Enquiry:
*required fields
Send to:
E:\Inetpub\vcrc2\form_lens\mail_info.txt
Yes I would like to try contact lenses free of charge
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Vision CRC
Rupert Myers Building Sydney NSW 2052
Ph:
61 2 9385 7400
Fax:
61 2 9385 7401
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