AOPT - 2011-2012 Membership Application -Membership: Membership Application

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Contact Information:

	Telephone*	Fax
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Email*

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Your Fields of Interest:

Glaucoma	Macular degeneration	Clinical R&D
Anti-glaucoma drugs	Anti-angiogenic drugs	Pharmacokinetics
Aqueous humor dynamics	Diabetic retinopathy	Toxicology
Neuroprotection	Macular edema	Drug delivery
Neuropharmacology	Anti-diabetic drugs	Drug design
Biochemical & cellular pharmacology	Other retinal diseases	Medicinal Chemistry
Molecular biology and genetics	Inflammatory diseases	Analytical instrumentation
Gene transfer	Anti-inflammatory drugs	Psychophysics
Stem cells	Immunopharmacology	Imaging technologies
Receptors	Dry Eye	Others (specify)

Please enter your three preferred fields of interest from the above list

	Interest 1*
	Interest 2*
	Interest 3*

I am a:*
New Member
Renewing Member	(Member ID: )

Membership Category*	2 year membership 2011-2012 Fees*
Regular Member	$350.00
A Regular Member is an individual demonstrating a genuine interest in or making significant contribution to ocular pharmacology and therapeutics. This may be evidenced by a) scientific publications; b) attendance at pharmacological, ophthalmological, optometric, or visual science meetings; c) direct involvement in research; d) working in the fields of ophthalmology, optometry, or visual science. A candidate for membership should complete this online form followed by clicking on the “Submit” button at the bottom, or should mail/fax the form to the Treasurer accompanied by the appropriate membership dues. Membership is for two years and includes a subscription to the Journal of Ocular Pharmacology and Therapeutics.
Indicate journal subscription preference online print no subscription needed*
Associate Member (Pre/Postdoctoral students, Fellows)	$30.00
Associate Membership is for predoctoral and postdoctoral students. A candidate for this status completes this online form followed by clicking on the “Submit” button at the bottom, or should mail/fax the form to the Treasurer accompanied by the appropriate membership dues.
Contributing Member (Corporation, Sponsor)	$2,000.00
Contributing Membership is restricted to corporations, associations, and individuals who support the objectives of AOPT but do not satisfy the requirements of Regular Membership or individuals elected to membership in any class who voluntarily choose to become Contributing Members. A candidate for this status should complete this online form followed by clicking on the “Submit” button at the bottom, or should mail/fax the form to the Treasurer accompanied by the appropriate membership dues.
* 2-year membership period: January 1, 2011 through December 31, 2012. Rates are in US dollars.