Personal Info
Employment Info

Full Name:

Employeed By:

Home Address:

Company Name:

City:

Address:

State:

City:

Zip:

State:

Home Phone:

Zip:

Cell:

Phone:

Email:

Fax:

DOB:

Years Employeed:


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Professional Certification

ABO#:

Expiration date:

ABOA#:

Expiration date:

ABOM#:

Expiration date:

NCLC#:

Expiration date:

CPOA#:

Expiration date:

STATE/LICENSE#:

Expiration date:

JCAHPO#:

Expiration date:


Professional Affiliations
Education Level

High School

Associate

Bachelor

 

 
 

   

Membership: New Member Renewal    

Regular

$125.00 Any person ABO/NCLC certified and/or Optician State License and/or has dispensed for at least three years.

Credit Card Information

Card Number:

Expiration date:

/

CVC:


In submitting this application, I agree to abide by the bylaws of the association and adhere to the Code of Ethics.
I also understand that the Board of Directors of the Opticians Association of Illinois will approve all applications.

       
       

 

2016 OAI SPRING CONFERENCE
March 11 - 13, 2016
Lincolnshire Marriott Resort
Ten Marriot Drive
Lincolnshire, IL 60069
847-634-0100

 

Click here for more information

Certifications

Do you need to renew your certifications? If so, the OAI is the perfect place to receive certification hours. Our classes range from ABO Prep courses to NCLEC classes to ABOC credits.

Membership Registration

You now have the option to register online for your OAI Membership. Your Membership with us also includes you as a Member of the OAA, Opticians Association of America.