Armed Forces Optometric Society - Membership Application
Please complete the form below.  Also, please remember to go to PayPal and submit your payment information.
AFOS Application
* Name: First, Mi., Last
   Maiden Name (If Applicable)
   Home Street Address
   City
   State
   Zip Code
   Telephone
* E-Mail Address
   Business Street Address
   City
   State
   Zip Code
   Telephone
* Send Mail To
* Gender
   Date of Birth (Month, Day, Year)
   Optometry School Attended
   Graduation Date (Year)
   Original License Year
   State (s) Licensed In
   Have you completed a residency?Yes No
   If applying for active membership, list branch
   Date entered full time service (Month, Day, Year)
   If applying for associate membership, list previous service
   Are you currently?
   Are you currently part time?
   If applying for active membership, will your AOA application be as a new member?Yes No
   Will your membership be as a transfer?Yes No
   If yes, which state?
   Will your membership be as a reinstatement?Yes No
   If yes, which affiliation and date (s)
   If yes, previous AOA number
   If applying for student membership, which school are you attending?
   If applying for student membership, what is your graduation date?
   If HPSP recipient, which branch?
   What is your OE Tracker #
   Any additional comments or suggestions?
Confirm Number