Member Registration – Asia Pacific Ophthalmic Trauma society

Name*
First Name (Required) Middle Name (Required) Last Name (Required)
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
Nationality*
Basic Qualifications, Year and University*
Post graduate (Residency) Ophthalmology Qualification / Institution*
Fellowship (Speciality)*
Institute*
Year*
Current Affiliation(s) and Position*
Institute / Clinic / Hospital Address*
Academic Interest*
Contact Phone*
Fax
Email*
Website
Work Experience*
Place*
Year*
Other Professional Memberships*
Organization & Membership Number*
Trauma relevant Publications / Presentations. List all the Publications / Presentations related to Trauma*
Upload your Photo
Accepted file types: jpg, png, Max. file size: 1 MB.
Accepted file types: jpg, png. File size should not exceed 1 MB
Membership Type*
- Lifetime Regular Membership
- Allied Health Membership
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Upload the letter of training from the Institute
Accepted file types: jpg, png, pdf, Max. file size: 5 MB.
Amount Payable
$0.00
- Subscribe to APOTS newsletter
Payment Method*
- Paypal or Credit Card
- Bank Transfer