#5315-ISRS/AAO ApplicForm Final

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Application for ISRS Membership
International Society of Refractive Surgery
Applications must be received by 31 August 2015 to qualify for the discount
for Refractive Surgery Subspecialty Day Meeting, the ISRS Annual Meeting, in Las Vegas.
First Name
A Partner of the American Academy of Ophthalmology
Medical Degree (e.g. MD, MBBS, etc.)
Family Name
Mailing / Postal Address
Date of Birth
Home o
Office o
(Please check one)
City
State/Province
Postal Code
Country
Office Phone
Fax
Website
Email
Medical School Name
Completion Date (MM/YYYY)
(Required)
(Required)
Ophthalmology Training School Name
(Required)
City
State & Country (if outside U.S.)
Beginning Date (MM/YYYY)
Completion Date (MM/YYYY)
(Required)
(Required)
AAO Member? (If so, please provide Academy ID#)
M E M B E R S H I P
L E V E L S
Applicants can pay their application fee to join this year, as well as
their membership dues for the following year.
U.S. and International Members
o 1 year $235 USD
o
P A Y M E N T
o American Express o MasterCard o Visa o Discover
o JCB o Check or Money Order Enclosed
For wire transfer information, please email [email protected]
2 years $455 USD
The different dues rates are based strictly on the completion
dates of your training (residency or fellowship).
1st Year in Practice
o 1 year $150 USD
o
2 years $305USD
2nd Year in Practice
o 1 year $160 USD
o
2 years $325SD
3rd Year in Practice
o 1 year $170 USD
o
2 years $335 USD
Card Number
Exp Date
Name on Card
Signature
Cardholder’s Address
Associate Members
For non ophthalmologists (MD, DO, DVM or PhD) working in
the field of ophthalmology or engaged in full-time ophthalmology
research.
City
o
State/Province
1 year $235 USD
o
2 years $455 USD
Members in Training (includes online Journal only)
o
No cost
A letter of verification from your Professor/Program Chair with your
begin and end dates must be submitted with application.
o Journal of Refractive Surgery Subscription (One Year)
Total Amount Due: $
USD
$100 USD
Postal Code
Country
Please return your completed application to:
ISRS and AAO Member Services
Dept. 34048
P.O. Box 39000
San Francisco, CA 94139 USA
Tel:
+1.415.561.8581 or toll-free (U.S. Only) 866.561.8558
Fax:
+1.415.561.8575
Email: [email protected]
Do not write in this space, for accounting only:
Payment Received
Date
Lockbox Batch # (if applicable)
Amount
By
International Society of Refractive Surgery
A Partner of the American Academy of Ophthalmology
Join ISRS
www.isrs.org
Become a member of the International Society of Refractive Surgery (ISRS), a partner of the American
Academy of Ophthalmology. ISRS is the leading organization for refractive surgeons and keeps you
up-to-date on the latest clinical and research developments in refractive, cornea, cataract and lens-based
surgery. Members are connected to the world’s leading refractive surgeons from over 80 countries
through ISRS’ innovative meetings, popular publications and online educational tools.
Membership acceptance is subject to review and approval by the ISRS Executive Committee.
Benefits of Membership
• Subscription to the Journal of Refractive Surgery, the
official publication of ISRS, a monthly forum for original
research, review and evaluation of refractive, cataract,
cornea and lens-based surgical procedures. (Online subscription for Members in Training.) NEW! Download the
Journal to your iPad or iPhone.
• Access to the exclusive ISRS Multimedia Library providing
refractive, cataract and cornea videos, presentations and
conversations shared by leading surgeons from around the
world.
• Access to the ISRS Online Community, a place to
exchange clinical information, comment on the most recent
advances and theories in refractive surgery and receive
advice from colleagues worldwide.
• Reduced registration fee for the 2015 Refractive Surgery
Subspecialty Day, the ISRS Annual Meeting, an
innovative meeting that assembles international leaders
in refractive, cornea, contact and lens-based surgery,
providing a forum for exchange of the latest information
in the field.
• Complimentary online listing for your practice in Find a
Refractive Surgeon, a public online directory that allows
patients and colleagues to easily find you.
• Access to content on the ISRS website, www.isrs.org,
including the latest trends, news and information on
refractive and cataract surgery to further your knowledge
and education.
• Complimentary membership certificate.
• Invitation to ISRS supported educational events around
the world at international meetings with other ophthalmic
societies.
• Members of ISRS, who are not already members of the
American Academy of Ophthalmology, receive a $100
discount on the Academy’s membership application fee.
For more information and an application, go to the Academy
website at www.aao.org or contact Member Services at
[email protected].
How to Join
• Access to refractive and cataract information on the
Academy’s Ophthalmic News and Education (ONE®)
Network, the world’s most comprehensive ophthalmic
education resource.
Please complete the application on the reverse side or join
online at www.isrs.org.
• Subscription to Refractive Surgery Outlook, a monthly
clinical e-newsletter featuring expert opinion on the latest
advances, highlights from peer-reviewed clinical journals,
a calendar of events and ISRS information.
If you have any questions or would like additional
information on any of these programs and services, please
email ISRS at [email protected] or call us at
+1.415.561.8581 or toll free (U.S. only) 866.561.8558.