OAO Membership Dues OAO Dues Payment Form Practice*Name* First Last Email* Address (please enter new address if you have moved) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 2020 OAO Membership Dues Enter your 2020 dues amount here2019 OAO Membership Dues - PAST DUE Please enter the PAST DUE amount you'd like to payPAC Contribution (optional amount) PAC contributions support OAO’s legislative efforts to maintain quality eye care and assure that surgery is performed only by medical or osteopathic surgeons. PAC contributions are credited for the calendar year in which you contribute. Optional 2020 PGC Registration Price: $435.00 Quantity: Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.