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Membership

Online Membership Application Form

Directions: Please complete the membership application form below. Mandatory fields are marked with an asterix. Once complete, click the Submit Application Form button at the bottom of the page. Your membership application form will be sent to the ION Company Secretariat for processing. You may be contacted if more information is required, or to validate your identification. You will be notified by the Company Secretariat via e-mail when your application has been processed.

Personal Details:

Title: * eg. Dr., Mr., Prof.
First Name: *
Surname: *
Qualifications: * eg. MBBS, FRANZCO, FRACS

Address for Correspondence:

Street: *
Suburb: *
Post Code: * eg. 4000, 4004
State: * eg. QLD, NSW, CA
Country: * eg. AU, USA
Practice Name:
Other Practice affiliations:
Day Surgery / hospital affilliations:

Contact for Correspondence:

Phone: * eg. 01 2345 6789
Fax: eg. 01 2345 6789
E-Mail: * eg. name@domain.com
Mobile: eg. 0123 456 789
Website:
Contact Person: (eg Practice Manager, PA, Receptionist etc):
Contact Persons Email:

Membership Option:

Note: Membership to ION is limited to independent ophthalmologists, independent non-ophthalmologists, and ophthalmologists in training not employed nor affiliated with publicly listed, ophthalmology organisations and affiliated organisations. For more information, please contact the ION Company Secretariat.

Membership Option: *Independent Ophthalmologist$200.00 per annum
Independent Non-Ophthalmologist$200.00 per annum
Associate Member (Ophthalmologist in Training)FREE
Retired Member (Retired Ophthalmologist)FREE
Declaration: *I declare that I am not an employee nor affiliated with any publicly listed, corporatised ophthalmology organisations, nor affiliated organisations.
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