Member Renewal Form | New Hampshire Opticians Society

Your 2020 membership is now due. As the Executive Board needs to maintain a current data base, it is important to take a few minutes to answer ALL the questions below.

Name*

Place of Business*

Business Address*

Street Address Address Line 2 City State ZIP Code

Home Address

Street Address Address Line 2 City State ZIP Code

Work Phone*

Cell Phone*

Home Phone

Email Address*

Dues

INITIATION FEE: $50.00
CERTIFIED/REGULAR: $100.00
ASSOCIATE: $50.00
STUDENT: $35.00 (No initiation fee required)

Membership Status

CERTIFIED – ABO, NCLE, OR State Licensed optician
REGULAR – Registered Dispensing Optician, living and/or working in the state of New Hampshire
ASSOCIATE – Any other person concerned with advancing the objectives if this organization
STUDENT – Anyone enrolled full-time in an ophthalmic dispensing program at an accredited

Total

$0.00

Optical Memberships

ABO CERT #*

NCLE CERT #*

Do you have a valid license in any other state?*

Yes
No

Where?*

Phone

This field is for validation purposes and should be left unchanged.