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MEDIA REQUEST FORM

Members of the media who would like to receive additional information about TLCVision^® or laser vision correction, or would like to be contacted by our Corporate Communications department may fill out the form below. If you wish to speak directly with a member of TLCVision's Corporate Communications department , please call
1-888-289-5824 ext. 2319.


First Name*:
Last Name*:
Title:
Publication/Station:
Type of Publication:
Address:
Suite:
City/Town:
State/Province:
Zip/Postal Code:
Country:
Daytime Phone: (including area code)	-
Fax: (including area code)	-
E-mail Address*:
(to ensure a reply, please enter your e-mail address correctly)

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