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Outreach and Community and Professional Affiliations
Society Group Member
Are you a member of a local Society Group/Chapter?
- Yes
- No
Society/Group
Please specify
Speak to Media
Are you willing to speak on radio, television, or to a print journalist about optometric issues?
- Yes
- No
Advocacy
Are you interested in participating in political advocacy for the profession? (Ex: Contact your MPP or participate in a political fundraiser?)
- Yes
- No
Community Events
Are you willing to participate on behalf of the OAO in community events such as health fairs, presentations to local groups, schools, or companies?
- Yes
- No
Commmunity Club/Association
What community club or professional association do you belong to?

Education and Training
Degree
Did you obtain an Accredited Professional Optometric Degree?
- Yes
- No
Institution Name (POD)
If yes, please provide institution name and year of graduation:
Graduation Year
International Optometric Bridging Program
Did you complete the International Optometric Bridging Program?
- Yes
- No
Institution Name (OBP)
If yes, please provide institution name and year of graduation:
Graduation Year
Designations
List any Degrees and Professional Designations (eg FAO, MSc, etc)

Mailing Information
Mailing information
Please select where Association mail should be sent.
- Home address
- Practice address
- Other
Address
Address
City
City
Province
Province
Postal Code
Postal Code
Country
Country

Patient and Public Referral
Patient/Public Referral
OAO receives calls from the public inquiring about services provided by optometrists. Would you like OAO to refer patient/public inquiries to you in your practice when asked for an optometrist that provides specific services or speaks a certain language?
- Yes
- No

Confirmation
By submitting this form, I hereby apply for a membership in the Ontario Association of Optometrists (OAO). I agree to abide by its constitution, bylaws, and Ethical Guide for OAO Members, and to promptly advise the OAO of any change in practice location. As an OAO member, I understand and agree that my name, practice address(es) and practice phone number will be posted on the OAO website for public access through the 'Find an Optometrist' program. Unless otherwise stated. information (other than noted above) requested in the following pages is kept confidential and will be used by OAO solely to: 1. Develop policy and proposals advocating for the profession with the Ontario government; 2. Evaluate and expand member resources, benefit programs and services.
Comments
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Outreach and Community and Professional Affiliations

Practice Information: General	Address	City	Province	Country	Postal Code	Phone Number	Fax Number	Available facilities	Other	Available facilities	Specialty Contact Lenses	Services Offered (Other)	Actions
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