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Membership Application

Thank you very much for your interest in our society.

If you wish to become an APSOPRS member, please fill out the Online Application Form and then submit the following membership requirements to APSOPRS secretariat by an email to info@apsoprs.org:

Membership Type*
*
Personal Information*
Last name *
First name *
Gender *
Primary email address *
Secondary email address(if any) *
Teaching/Academic Appointment*
Institution Position *
Hospital/Academic affiliation(s) *
Name *
City, State, Country, PIN Code *
Practice address* (Required for shipping APSOPRS membership certificate) *
Residential address *
Telephone*
Tel. Country code *
Telephone Number *
Country of Registration/Practice (Asia-Pacific) *
Institution / Country / Year of graduation *
Medical graduation degree (provide documentary evidence*)
Fellowship training(provide documentary evidence*)
1) Institution, State, Country *
Period of training *
Preceptor(s) *
2) Institution, State, Country
Period of training *
Preceptor(s)
Referees (Must be APSOPRS members in good standing)
1) Name *
Country *
Membership #
2) Name *
Country
Membership # *
Other Oculoplastic Society membership(s)*
National *
Membership Number
International *
Membership Number
Payment Options*
*
Requirements*
*
Required
Click "Add File" to upload the scanned requirements
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