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ASCRS Young Eye Surgeon Membership Request
Please note that YES membership is only available to U.S. based physicians.
Your Name
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Practice/Program Name
*
Your Primary Subspecialty
*
Your Secondary Subspecialty
*
Your Email
*
Your Contact Number
*
Address
*
Membership Type
ASCRS U.S. YES Membership – Year 1 ($100)
ASCRS U.S. YES Membership – Year 2 ($200)
ASCRS U.S. YES Membership – Year 3 ($300)
ASCRS U.S. YES Membership – Year 4 ($360)
ASCRS U.S. YES Membership – Year 5 ($420)
I consent to creating a YES membership and being contacted for payment.
Consent
If you are continuing or moving to a fellowship, please provide the expected end date below
Would you like to learn more about the business side of Ophthalmology with a free 3 month membership with ASOA?
Yes
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