Url Thank you for your interest in a five day supply of 10 PRECISION1® contact lenses for your personal evaluation. If you still wish to receive the trial, please fill in all of the information below and submit this form. All of the fields are mandatory. First Name * Last Name * Address * Alcon Acct # * PRECISION1® is available in the following power range (diopter) : -0.50 to -6.00 (0.25D steps), -6.50 to -12.00 (0.50D steps), +0.50 to +6.00 (0.25D steps), +6.50 to +8.00 (0.50D steps) OD OS Acknowledgment By completing this section and submitting this form, I as an optometrist am acknowledging: • That the requested lenses will be used for my personal evaluation and are not for anyone else,• That the above is my current, accurate vision prescription, and• That the requested lenses will not be sold or bartered to any third party or submitted for reimbursement to any insurer or health provider, public or private. Authorization Authorization I understand that I am voluntarily disclosing my personal information including my name and lens prescription (Personal Information) to Alcon and its service providers for the purposes of this free evaluation (together, the “Alcon Group”) so that the Alcon Group can fulfill my request to receive a trial set of PRECISION1® contact lenses for personal evaluation. I understand that once my Personal Information is disclosed, it may be temporarily stored by a member of the Alcon Group on servers in Canada or in the United States; accordingly, it may be subject to a valid request for disclosure under the USA PATRIOT Act or other similar legislation. I understand that I may refuse to fill out this portion of this registration form and still be able to attend the Precision1 virtual launch event. I also may revoke (withdraw) this authorization at any time in the future by calling Alcon Customer Service at: 1-800-268-4574 or by writing to: Alcon Canada Inc. Attn: Customer Service 2665 Meadowpine Blvd. Mississauga, Ontario L5N 8C7 My refusal or future revocation will not affect my ability to attend the PRECISION1® launch event; however, if I revoke this authorization, I will no longer be eligible to participate in the personal evaluation of contact lenses. If I revoke this authorization, the Alcon Group will stop using or sharing my information (except as necessary to end my participation) but my revocation will not affect uses and disclosures of my Personal Information previously disclosed in reliance upon this authorization. I understand that this authorization will remain valid for 1 month, unless I revoke it earlier. I understand that I have the right to receive a copy of this form. © 2020 Alcon Inc. 06/20 CA-PR1-2000077 See product instructions for complete wear, care and safety information.