Last Name:      First Name:  

Address:      

City: State: NY AL AK AZ AR CA CO CT DE FL GA MA ME NC NJ OH PA RI SC VA VT Zip Code: 

Home Phone:       Work Phone: 

Fax #             E-Mail Address    

                  Preferred Address:  Home  Business   Preferred Phone:    Home    Business

      The Membership year runs from the Date you join and for one year hence

          Membership Type    Pick One      Active Membership $75.00 Industry Member $75.00 Retail Corporate Member $150.00 Student Member $10.00

To be listed accurately in the  Membership Directory, Please indicate which of the following services are offered by your business:   

Artificial Eyes Contact Lenses Eyeglasses Hearing Aids Low Vision Refractions Available

Please Indicate to which organizations you belong:

American Board of Opticianry Certified   (ABO)

Contact Lens Society of America  (CLSA)

Fellow, National Academy of Opticians  (FNAO)

Opticians Association of America  (OAA)

National Contact Lens Examiners  (NCLE)

NYSSO Member                           Which Chapter

Click on the Chapter of your choice to join

Chapters  Long Island- Nassau Lower Hudson Valley

NYS License #         

CL License #              

Date Of Birth                             

Sex:       Male Female

Please Complete the application, press the submit button to email it to us,  place your check in the mail today.

Opticians Alliance of New York Inc.

PO Box 631

Oceanside, NY 11572-0631             

             After Submitting Application click on the return to form link e Pay and confirm button to go to Pay Pal for payment options.