If you need to pay your membership click here

If you need to contribute to PAC click here

Para Miembros Internacionales presione aqui

 

Application for Membership

NAME: FIRST NAME: || LAST NAME: || TITLE:

--------------------------------------------------------------------------------------------------------------------------

MARITAL STATUS : .................. SPOUSE'S NAME:

--------------------------------------------------------------------------------------------------------------------------

OFFICE ADDRESS: E-MAIL ADDRESS:

CITY: .......STATE: ............ZIP: ..............COUNTY:

OFF PHONE: ..................... OFF FAX:

--------------------------------------------------------------------------------------------------------------------------

STATE LICENSE # .............DATE :

MEDICAL SCHOOL ......DEGREE YEAR OBTAINED

INTERNSHIP/RESIDENCY ....... ...... YEAR OBTAINED

FELLOWSHIP PROGRAM .. .... .......YEAR OBTAINED

Other Professional Activities and Postgraduate Training Since Residency (Account for all time since residency in a
chronological sequence. Attach additional sheets if necessary.)

Membership dues of $250 must be received with this application as well as $50.00 Non-refundable fee applies to each applicant. checks must be payable to Miami Ophthalmological Society, P.O. Box 015869, Miami, Florida 33136

Name of MOS Member who recommend you:

 

 

To pay for your $150 annual membership you may:

1) Send a Check check of $150 payable to the Miami Ophthalmological Society and mail to:

Eti Salazar
Miami Ophthalmological Society
P.O. Box 015869
Miami, FL 33101

2) Pay Online here:

 

Every member of the MOS is encouraged to make a contribution to PAC each year to solidify and strengthen our overall political strategy. Contributions are voluntary . A contribution at any level including at a level below those listed is welcome.

Now you can contribute online your annual contribution or $100.

1) Send a Check check of $100 payable to the Miami Ophthalmological Society and mail to:

Eti Salazar
Miami Ophthalmological Society
P.O. Box 015869
Miami, FL 33101

2) Pay Online here:

 

One-Time Registration Fee

If you would like to attend a lecture, but you are not an MOS member, pay your one-time registration
fee here:

1) You may also bring a check in the amount of $75 payable to the Miami Ophthalmological Society and mail to:

Eti Salazar
Miami Ophthalmological Society
P.O. Box 015869
Miami, FL 33101

2) Pay Online here:

 

La Sociedad Oftalmologica de Miami se complace en ofrecer membresia a oftalmologos de Centro y
Sur America. Si usted desea inscribirse como miembro de nuestra sociedad, por favor llene la aplicacion que aparece arriba. La cuota de afiliacion para el año 2008 es de $150 e incluye:
Certificado de afiliacion
Anuncios de las conferencias
6 Seminarios al año que incluyen coctel y cena
Directorio de miembros

1) Envie su cheque de gerencia o giro postal por la cantidad de$150 pagadero a Miami Ophthalmological Society a la siguiente direccion:

Eti Salazar
Miami Ophthalmological Society
P.O. Box 015869
Miami, FL 33101

2) Usted tambien puede pagar via internet:

Haga un click aqui:

 

 

 
 
| HOME | SEMINARS | MEMBERSHIP | MEMBERS | SPONSORS | OFFICERS | ABOUT | RESOURCES |
Miami Ophthalmological Society
1638 NW 10th Avenue, Miami, FL 33136
Phone (305) 326-6099 - Fax (305) 326-6306
Contact us: support@mos-org.com