Student Applications - California Optometric Association
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Student Applications

Fields marked with * are required.

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California Optometric Association offers complimentary membership to students and post-graduate students of optometry.

 

First: *
Last Name: *
Middle Initial:

Preferred Mailing Address

Street Address: *
City: *
State: *
Zip Code: *
Telephone: *
School Email: *
Personal Email: *

Home Address

Street Address: *
City: *
State: *
Zip Code: *
Telephone: *

Demographics

Date of Birth (mm/dd/yy): *
Gender: *
Marital Status:
Name of Spouse (if applicable):
If your spouse is an OPTOMETRIST, list his/her license #:
Ethnicity:

Optometry Student

School of Optometry: *
Year of Graduation: *

Post-Graduate Student

Post-Graduate Student Membership requires certification of your full-time status by an appropriate offical of the post-graduate/residency program.

Post Graduate Program Type:
Post Graduate Program Location
CA License #:
Completion Date:

New graduates are exempt from dues for the balance of the year in which you graduate or complete your residency.

Post-Graduates/Residents are assessed $35 annual dues for AOA membership/COA dues are waived.




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California Optometric Association
2415 K Street, Sacramento, CA 95816 | 916-441-3990
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