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 2021 OAO Membership Dues Enter your 2021 dues amount hereOAO Membership Dues - Past Due or Other Amount Please enter the Past Due or Other amount you'd like to payPAC Contribution (optional amount) Oregon Foresight Ophthalmology PAC contributions support OAO’s legislative efforts to maintain access to safe, quality eye care and assure that surgery is performed only by MDs and DOs. PAC contributions are credited for the calendar year in which you contribute. Optional 2021 Virtual PGC Series Registration Price: $200.00 Quantity: Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.