Application for membership

  1. Candidate Info
  2. Contact Info
  3. Training/Experience
  4. Appointments/Teaching
  5. Research/Publications
  6. Societies/Sponsors
  7. Summary

Candidate information

*required

Name*

MD, PhD, MBA, etc

Membership

Are you applying for Active membership or Associate membership?

Active membership is limited to practicing physicians who hold a valid and unrestricted license to practice medicine and have been certified by the American Board of Ophthalmology or comparable board outside the United States.

Associate membership is limited to persons, other than practicing physicians, whose primary interest is in the basic scientific disiplines related to the study of the retina and its diseases.


Background

Gender*
Date of birth

Do you work for a commercial entity or industry? *

If yes, please describe:


Create login

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