Wearer Registration

Thank you for purchasing iZon High Resolution Lenses.

Please take a moment to register your new lenses with us. Just for registering and completing a short survey, we'll send you an e-coupon for two free Blockbuster movies. Just fill out the information below and hit “submit" – it’s that simple.

If you’d like to contact us by traditional mail, you can write to us at:

iZon Wearer Registration
iZon Lenses
1491 Poinsettia Avenue
Vista, CA 92081

*First Name
*Last Name
*Email
Address

*City
*State
*Zip
Telephone Number
Name of eye care professional and practice that supplied your iZon High Resolution Lenses

What type of iZon High Resolution Lenses do you have?
	Progressive Power Lenses, or PALs (for Presbyopia) Single Vision Lenses
Date of purchase
	Within the last 30 days 30-90 days ago 90-120 days ago 120+ days ago
Gender
	Male Female
Age
	Under 18 18-25 26-35 36-49 50-64 65+
Approximately how many years have you been wearing glasses or contact lenses before purchasing iZon Lenses?
	Most of my life 5-10 years 1-4 years Less than one year These are my first vision correction lenses
What is your primary form of vision correction?
	Contact lenses Glasses
How did you first hear about iZon Lenses?
	Written article Television news program Radio news program Advertisement (newspaper, magazine, TV, radio, etc.) The Internet A relative or friend (please let us know their name) My Eye Care Professional Other (please tell us more)
	Thank you for registering!

* Fields required.

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