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Membership Renewal
When your membership is about to expire, we will send you a renewal notice.
If you wish to renew your membership, please fill out the Membership Application Form Online.
You can choose to renew your 2 years membership ($100 USD) or to apply for life membership ($500 USD).
Please complete your payment online or via bank transfer, and then we will send you a confirmation email in a few days.
Membership Type*
*
Personal Information*
First name *
Your answer
Last name
Your answer
Gender *
Primary email address *
Your answer
Secondary email address(if any)
Your answer
Teaching/Academic Appointment*
Institution Position *
Your answer
Hospital/Academic affiliation(s)
Your answer
Name *
Your answer
City, State, Country, PIN Code *
Your answer
Practice address* (Required for shipping APSOPRS membership certificate) *
Your answer
Residential address
Your answer
Telephone*
Tel. Country code *
Your answer
Telephone Number *
Your answer
Country of Registration/Practice (Asia-Pacific) *
Your answer
Institution / Country / Year of graduation *
Your answer
Medical graduation degree (provide documentary evidence*)
Your answer
Fellowship training(provide documentary evidence*)
1) Institution, State, Country *
Your answer
Period of training *
Your answer
Preceptor(s)
Your answer
2) Institution, State, Country *
Your answer
Period of training
Your answer
Preceptor(s) *
Your answer
Referees (Must be APSOPRS members in good standing)
1) Name *
Your answer
Country
Your answer
Membership # *
Your answer
2) Name
Your answer
Country *
Your answer
Membership #
Your answer
Other Oculoplastic Society membership(s)*
National *
Membership Number
Your answer
International
Membership Number
Your answer
Payment Options*
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