Arkansas Ophthalmological Society Arkansas Eye M.D. Contents indicates current page Home AOS Home Page Find An Eye MD Locate an Eye MD In or Near Your Town General Information About Ophthalmology and the AOS Membership Information For Ophthalmologists Wishing to Join Benefits of Membership Types of Membership Apply for Membership Online Application Form Members Only Section Resources Exclusively for AOS Members Internet Links Ophthalmic Practices and Resources Site Guide ArkEyeMDs Navigation Made Easy Feedback Questions, Comments, Suggestions   Arkansas Ophthalmological Society AOS Membership Application Fields marked with an asterisk (*) are required. Personal Information First Name* Middle Name Last Name* Suffix (Jr., III, etc.) Gender* Male     Female Office Address* City State Zip Country Office Phone* Office Fax Home Address* City State Zip Country Home Phone Preferred Mailing Address* Office Home E-mail Address Date of Birth (mo/day/yr)* Medical Education & Background Degree* Medical Doctor Doctor of Osteopathic Medicine Medical School* Month and Year of Graduation* Internship Hospital* Dates of Duration* Residency Hospital(s)* Dates of Duration* Special work in Ophthalmology (Fellowships) Are you Board Certified (American Board of Ophthalmology)?* Yes No If so, date of certification Medical License Number and State of Licensure* Number State or Country First year of practice*: Type of Practice* General Subspecialty in Type of Membership Membership Category* (click here if unsure) Active Associate Emeritus Honorary Affiliate Et Cetera Notes, Comments, Special instructions, etc. Legalese I hereby make application for membership in the Arkansas Ophthalmological Society, and I agree to support its By-Laws, to practice in accordance with the established usages of the profession. I further agree that my typed name below may stand as my signature. Type Name for Signature* Date* Thank you for your interest in AOS and your commitment to your profession. You will be contacted by phone.   Please read our Disclaimer. If you have suggestions for improvements, please fill out our online comment card, or email us. Please report any problems to our Webmaster. Arkansas Ophthalmological Society Laura Harrison - Executive Director PO Box 55088 Little Rock, AR 72215-5088