YOUR ‘Everyone Belongs’ PHOTOS

Upload a photo to the contest

CONTACT INFORMATION:

Your photo(s) will be published to the gallery with your first name, city, and province/territory.

1

First Name *

2

Last Name *

3

City *

4

Province/Territory *

5

Your Email *

6

Re-enter Email *

7

Instagram Handle

8

Where did you hear about us? *

PHOTO DETAILS:

Accepted file types: jpg, jpeg, png, gif

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Select image(s) *

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Help us improve our eye health education by answering the question below:

To what extent do you agree or disagree with the following statement:
“Only ophthalmologists, who are medical doctors with specialized training in eye surgery, should perform surgeries on the eyes.” *

Strongly disagree Somewhat disagree Somewhat agree Strongly agree I don’t know

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*

By submitting this form, you agree to the full contest Rules & Regulations (see below), and you also certify the following to be true:*

You are 18 years of age or older
You live in Canada
You consent to the use of your photo for promotional purposes by the Canadian Ophthalmological Society
You own the copyright to your contest photo entry as its author
Your subject(s) are 1) over the age of 18 and have given consent for the use of his/her image or 2) you have permission from a parent/guardian for submission

*Required field.

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I agree to receive future contest announcements and other promotional communications from the Contest Sponsor.

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