Join OAO | Oregon Academy of Ophthalmology

Please fill out the form below. Your application will be forwarded to the board for approval and you will hear from us soon! Click here for more information on OAO membership benefits and membership dues.

By filling out and submitting the form below, I am applying to join to the Oregon Academy of Ophthalmology.

Name:*
Business Email:*

Business Email for OAO staff only – this email address will not be published.
Personal Email:

Personal Email is for OAO staff only – this email address will not be published.
Cell Phone:*
Cell Phone is for OAO staff only – this phone number will not be published.
Office Information (1):
Business Name (1):*
Business Address (1):*
Street Address Address Line 2 City State ZIP Code
Business Phone (1):*
Office Manager Name:*
Office Manager Email:*
Office Information (2):
Business Name (2):
Business Address (2):
Street Address Address Line 2 City State ZIP Code
Business Phone (2):
Personal Information:
Home Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

This information will not be published or shared.
Professional Education:
Medical School:*
Medical School Year Graduated:*
Residency School:*
Residency Year Completed:*
Fellowship School:
Fellowship Trained Subspecialty (if any):
Year Fellowship Completed:
Practice Focus:*

Please list all areas in which you treat patients. This is used for clients to find specific ophthalmology services on our website.
Other Society Memberships:
- OMA
- County Medical Society
- AAO
- Other
If Other – List Society:
Membership Sponsored by:
Proposed by (OAO Member):*
Seconded by (OAO Member):*
A dues statement will be mailed to you upon election to the Oregon Academy of Ophthalmology.

According to the OAO Bylaws, Section 2(a), “Each candidate for membership as an Active, Member-in-Training, or Non-resident member shall submit an appropriate membership application form supplied by the Academy. The form shall be completed in full, signed by two current Active or Non-resident members of the Academy as sponsors of the applicant, and returned to the Academy for review. (b) A notice of application for membership shall be submitted to the Academy members together with a call for comment by a date certain. If no objections are received, the applicant shall automatically become a member in the appropriate category.”
Phone
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Office Information (1):

Office Information (2):

Personal Information:

Professional Education:

Membership Sponsored by:

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