- What Is An Optician?
- Why is it important to see a Georgia licensed Optician?
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OPTICIANS ASSOCIATION OF GEORGIA
PAYPAL MEMBERSHIP/RENEWAL APPLICATION FOR 2018
Check one: ____ New Application ____Renewal
***(renew by March 31st for discounted meeting registration rate)***
I dispense: ____ Contacts ____ Eyeglasses ____Both ____ N/A
Name___________________________________________ License/cert # __________
Preferred Name for Badge _________________________________________________
City _________________________________State ________Zip code _____________
E-mail _______________________________________ Phone____________________
Please include me on the OAG EMAIL LIST to receive urgent information regarding legislation and issues that directly affect the profession of Opticianry: Yes____ No____
(E-mail addresses will be used for OAG communication only: It will not be shared with other organizations or used for other purposes.)
Education: Degree________ Major______________ College_________________
Certifications: ABO ____ NCLE ____ Refractometry _____ Other___________
____Professional ($125.00/ one year) ____Professional ($225.00/ two years)
____Professional ($275.00/ three years) ____Associate (Non-License $75)
____ Professional Veteran/Senior Discount ($112.50/one year)***
____ Professional Veteran/Senior Discount ($180.50/two year)***
____ Professional Veteran/Senior Discount ($247.50/three year)***
(*** Verification may be required)
____New Licensed Optician (year of licensure is free) Date Licensed _____
____Student Optician (n/c) ___________________________College
PRINT OUT THIS FORM TO FILL OUT, PRINT LEGIBLY, AND MAIL TO:
OAG PO Box 868 Lithia Springs, GA 30122 OR FAX TO: 770-528-0305
OR SCAN AND SEND TO: [email protected]
Membership Year Is From January 1 until December 31 of the Current Year
You MUST renew your membership prior to January 31, 2018 to be eligible to register for events at the Current Member discounted price.
Voicemail - (678) 658-2020 Fax – (770) 528-0305 Email - [email protected]
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