Please note that the Longest Loved Campaign finished on the 10th of October 2008. Winners will be announced at the AAO 2008 in Atlanta.

We are sorry that we cannot accept any more entries at this stage.

Please fill in the form in as much detail as possible. If possible, please supply a picture of you with the slit lamp (Haag-Streit may wish to use images submitted for promotional purposes. Any images used will be credited to the name on the entry and the institution).


Slit Lamp Model  
Serial Number (click on the images on right side)  
Ownership  
User name  
E-mail address    
Telephone number  
Name Clinic / Hospital  
Country  
City  
   
Please complete the
following statement:		 Using a Haag-Streit Slit Lamp for me means:
  
Picture
(jpg format, max. 2MB)