We are proud of our 2016

"Ophthalmic Optician® of the Year" recipient Barry E. Santini, O.O.



Society to Advance Opticianry Application Form and
renewal form (print this page and MAIL, Fax, or Email)

SAO
3636 Bee Cave Road, #102
Austin, Texas 78746

QUESTIONS? email us at: info@OphthalmicOptician.org
​or Fax us at (512) 328-4735


PRINT FORM, Fill out and Send current information with Check or Credit Card infomation

Name __________________________________Accreditation Suffix (ABOC, NCLEC, ABOM, etc.)________

Street Address_____________________________________________________________________

City__________________________________________ State ___________ Zip Code ___________

Email ___________________________________________________________________________

Phone______________________________________ Fax__________________________________

State License Number (if applicable) _________________  
 
College Attended ___________________________________________Degree_________________

College Address ___________________________________________Date of Degree___________

College City___________________________ College State ________ College Zip Code _________

Please attach an unofficial copy of your transcript from your college, a photo copies of your licenses if applicable, and photo copies of your ABO/NCLE certifications with this application.

Check Type of Membership and Dues Rates:

Candidate Ophthalmic Optician one time fee (No documentation needed / all are welcome)…………………..….... $ 25.00 □

Ophthalmic Optician New Membership Application fee (Non-refundable/Includes 1st year dues&Certificate) .. $159.00 □

Ophthalmic Optician Annual Membership (Due on May 31st each year/Late on June 1st/6mo. Grace period) .. $ 59.00 □

Corporate sponsorship ……………………………..………….................................................Donations accepted   $________

(Referred/Mentored by ________________________________)

Method of Payment:  □ Check enclosed payable to SAO        □ MasterCard        □ Visa

Card Number __________________________________________ Exp. Date _______ VCode _____

Signature ________________________________________________________________________
​(SAO Dues are 501-c3 qualified and are a tax deduction as a business expense only​)