APACRS Membership

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Membership Type
Ordinary Membership	US $100 per annum (Minimum 2 years)
Associate Membership	US $50 for 3 years

Personal Information
Family Name	:
First Name	:
Middle Initial	:
Title	:
Designation	:
Institution	:
Department	:
Address	:	Business Home
City/Postal Code	:
Country	:
Email	:
Tel No	:
Fax No	:
Medical School	:
Residency	:
Year Completed	:
Ophthalmic Training	:
Highest Qualification	:
Year Completed	:
No. of Years in Ophthalmic Practice	:
Subspecialty Interest	:
Have you performed intraocular implant surgery?	:	Yes No If Yes, estimate no. of operations:
Have you performed refractive surgery?	:	Yes No If Yes, estimate no. of operations:

Membership in this Association is subject to approval by the APACRS Board of Officers.