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
2309 Sudderth Drive
Ruidoso, NM 88345

QUESTIONS? email us at: info@OphthalmicOptician.org
​or Fax us at (575) 315-2248


PRINT FORM, Fill out and Send a one time charge of $25 to become a Candidate Ophthalmic Optician (NFOS SCHOOL STUDENTS NO CHARGE) along with current information on the first five lines found above the ********** with Check or Credit Card information to:

SAO
2309 Sudderth Drive
Ruidoso, NM 88345
(575) 315-2248 Fax

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

Street Address_____________________________________________________________________

City__________________________________________ State ___________ Zip Code ___________

Email ___________________________________________________________________________

Phone______________________________________ Fax__________________________________
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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​)