Licensed medical doctors (M.D. or D.O.) who have successfully completed their ophthalmology residence may apply for membership by submitting a completed application form.

Account information
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Provide a password for the new account in both fields.
1-Personal Information
Please enter your first name
Please enter your middle name (optional)
Please enter your lastname/surname
Please enter any suffix to your name (Jr., Sr., III, IV, etc.)
Please select your degree
Home Address
Second line of home address (if needed)
City of Home Address
State of home address
ZIP or Postal Code of Home Address
Home phone number
2-Office Information
Office Address
Office address, line 2 (if needed)
City of office
State where office address is located
ZIP or postal code
Office phone number (please use format (###)###-####)
Office FAX number (please use format (###)###-####)
Website of your practice, office, or group
3-Professional Information
Location where residency completed The content of this field is kept private and will not be shown publicly.
Dates of residency The content of this field is kept private and will not be shown publicly.
County medical society(ies) of which you are a member The content of this field is kept private and will not be shown publicly.
Recommending member of DAO The content of this field is kept private and will not be shown publicly.
Recommending member of DAO The content of this field is kept private and will not be shown publicly.

Pick your sub-specialty (required field).

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