Application for membership
Please use this form to request membership to the European Glaucoma Society (fields marked with * are mandatory).

You will need a photograph (max. 1MB, jpg format) and permission from a sponsor (a Member of the Society, President of a National Glaucoma or Ophthalmological Society, or your Head of Department) to validate your application.

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Apply for:

  • Ordinary member
  • Extraordinary Member


Title:
Surname: *
First name: *
Date of birth: * dd -   * mm -   * yyyy
Affiliation: *
Work address: *
Town: *
Postal code: *
Country: *
Your photo:
(max 1Mb - jpg format)
*

Contact telephone number
 
Work: *
Home:
Mobile:
Fax:

E-mail address:

*
Secondary e-mail address:

Glaucoma subspeciality interest
Please select (all that apply):













Residency
 
Start year:
*
End year:
*
Institution(s):
*
City:
*
Country:
*


Start year:
End year:
Institution(s):
  
City:
  
Country:




Clinical Fellowship (if undertaken)
 
Subspecialty:
Start year:
End year:
Institution(s):
City:
Country:


Subspecialty:
Start year:
End year:
Institution(s):
City:
Country:




Research Fellowship (if undertaken)
 
Subspecialty:
Start year:
End year:
Institution(s):
City:
Country:





Current position
 
Start year:
Institution(s):
City:
Country:





Sponsor - The sponsor must be a current member of the EGS, the President of a National Glaucoma or Ophthalmological Society, or your Head of Department. Please ensure that you have asked your sponsor's permission before submitting the form.
 
Surname: *
First name: *
E-mail: *


Additional notes:

Before submitting this form, please type the four characters displayed above:


PLEASE DOUBLE CHECK ALL THE ABOVE AND

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Process

  • The application process can take place at any time, with proposals being considered at the next Executive Committee Meeting. Meetings are held every month.



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