Houston Ophthalmological Society

Membership Form

Click below to pay your membership dues or dinner fees. Thank you!

Houston Ophthalmological Society
Membership Form

Applicant Name

First Middle Last

Spouse

First Middle Last

Home Address

City

State Zip

Office Address

City

State Zip

Office Phone

Office Fax

Email


This email is required for HOS communication
and will not be displayed for public use.

AAO#

Date of Birth

Current Status with American Board of Ophthalmology:

 

Diplomate (Date of Certification: )
ABO Application Submitted
No ABO Application Pending

Please note that this application must be accompanied by:

 

1. The names of two Regular members of the Houston Ophthalmological Society who have agreed to endorse your application.

 

2. A letter of certification of completion of 36 months of formal residency training in ophthalmology from the Director of the training program.
(Send via email after submitting this form. Instructions to follow.)

 

3. A suitable photograph of head and shoulders made within the past three years.
(Send via email after submitting this form. Instructions to follow.)

 

 



Houston Ophthalmological Society