Early Bird Membership Form

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Membership Application Form

As a member of Tennessee Eye Surgeons (Tennessee Academy of Ophthalmology), you join your colleagues promoting the profession and speaking for ophthalmology with a single voice.

Benefits of Membership

Protect ophthalmology’s current scope of practice. This is one of the highest and most important priorities for TN Eye Surgeons. Our team works closely with the House of Medicine, other like-minded organizations, and doctors across the state to ensure patients are protected and the public has direct access to medical doctors trained in ophthalmology.

Government affairs work. TN Eye Surgeons employs McMahan Winstead & Richardson for lobbying services. MWR is recognized as a top-tier lobbying firm in Tennessee, and advocates for our profession at the State Capitol.

Coding seminars an Annual Scientific Meeting. Each year TN Eye Surgeons sponsors a coding seminar and annual scientific meeting. Instructors from the American Academy of Ophthalmology (AAO) present the most timely and accurate information. Dues-paying members receive discounted fees, and are also given discounts for additional enrollees. Non-members are not eligible for discounts.

Additional educational programs. Scientific CME and practice management meetings as well as ophthalmology personnel education (technical and front office) continue to be a priority. Dues-paying members receive discounts, and non-members pay up to twice the member rate for educational meetings.

Website and newsletters. Our website, tneyesurgeons.com, and regular newsletter provides critical legislative updates both federal and state, CME opportunities, ways to get involved in advocacy, calendar and events updates, and more. Our newsletter is only available to dues-paying members.

Public and external relations. The TN Eye Surgeons employs Owen Public Strategies, a communications and public relations firm located in Nashville, to assist with communications to dues-paying members, the media, and the public.

Membership Categories(Required)

Contact Information

Name(Required)
Gender(Required)
MM slash DD slash YYYY
Date of birth

Practice Information

Address of Practice(Required)
RENEWING MEMBERS MAY STOP HERE. NEW MEMBERS PROCEED BELOW. If you are a renewing member, you do not have to enter any further information and may scroll to the bottom for online payment. If you are applying to become a member for the first time, please fill in all remaining fields below.

Home Information

Home Information

Medical School

Address
(MD, DO, etc)

Residency

Address

Fellowship(s)

Address
Address

Other Training

Address

Specialization

Specialization 1
Specialization 2

Licensing & Certification

Is your license to practice medicine unrestricted and valid?
Are You Licensed in Tennessee?
MD: Are You Certified by the American Board of Ophthalmology
DO: Are You Certified by the American Osteopathic Board of Ophthalmology
Max. file size: 100 MB.

Restrictions

Restrictions
Are there any restrictions or circumstances that would affect your membership such as a felony record? Denied hospital privileges or voluntary surrender of hospital privileges? Licensed revoked, suspended or have limited license? Or any other information you should disclose?
If yes above upload explanation
Max. file size: 100 MB.
By signing this application, I acknowledge that the information herein is true, accurate and complete. I authorize any officer, director or staff of the Tennessee Society of Eye Surgeons (formerly TNAO) to review and verify any information I have provided. I understand that any incorrect or false information found in my application is grounds for revocation and if I do not abide by the TNAO Bylaws and Code of Ethics my membership may be revoked.
MM slash DD slash YYYY

Endorsement by Colleague

By signing this application, I know or have personal knowledge of the applicant and recommend them for membership in the Tennessee Society of Eye Surgeons (formerly TNAO). Upon request, I am willing to provide any additional information requested or required.
MM slash DD slash YYYY
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Credit Card

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