Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 162017-02-08 Name*____________________________________________________ Address Home* _______________________Business______________________ City Home* __________________________ Business_____________________ Zip-code+4*__________ Home* ________________ Business________________ Preferred Address Home* _____________ Business______________________ Telephone Home* _____________________Business_____________________ License Number ___________Cell Phone*____________Cell Phone Carrrier_____ E-Mail Address*______________________ Fax #_________________________ Membership in the Opticians Alliance of New York is for one year beginning with The Date your application is accepted for membership and running one year hence Membership fee is 100.00 Make checks payable to Opticians Alliance of New York Mail Application to Opticians Alliance of New York P.O. Box 631 Oceanside NY 11572-0631 OANY OFFICE PHONE 516-234-4040 Please indicate to which you belong · American Board of Opticianry Certified (ABO) · Contact Lens Society of America (CLSA) · Fellow, National Academy of Opticianry (FNAO) · Opticians Association of America (OAA) · National Contact Lens Examiners (NCLE) · NYSSO Which Region________________ What is the Opticians Alliance of New York doing for you? · Providing access to free Continuing Education credits thru our regular monthly meetings · Monthly Newsletter, Membership in OAA · Web site www.oany.org · Email notification of timely messages Payment Enclosed $________________________________________ Opticians Alliance Of New York Membership Application