TTOA Membership Registration / Renewal Form

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Please take a moment to review these 4 slides before proceeding. Thank You.
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Let's get started * This field is required.Can we have your NAME please?
First Name
Last Name
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Nice to meet you, are you currently a practicing Optometrist or Student Optometrist in T&T?* This field is required.NB. All regular TTOA members must be currently TTORC registered and in good standing.
Yes
No
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Can you let us know your Qualification(s)?* This field is required.If you are a Student, please indicate your School & Year
e.g. OD, BSc, BSc(Hons), MCOptom, with Credentialed Specialties, etc
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Do you have any professional Registration numbers or Foreign Optical Board Registration numbers?* This field is required.(if applicable to assign credentials after CET is completed; if none please put N/A)
e.g. GOC#, US State License(s)# & ARBO OE Tracker#, etc
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Please let us know your primary Email address* This field is required.
example@example.com
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We may need to reach you via personal cellular Phone Number* This field is required.
Main Contact *
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Are there any alternatives in case we don't get through?e.g Home phone/ Work phone
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Can you let us know where you currently practice/work?* This field is required.
Address Line 1
Address Line 2
Address Line 3
State / Province
Postal / Zip Code
Trinidad and Tobago
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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There are currently 3 types of Membership, which are you interested in?* This field is required.(Associate- Optometric professionals outside Trinidad and Tobago)
Regular - TT $800
Associate - TT $500
Student - TT $300
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A proof of payment is required to complete registration. Please attach below:* This field is required.Upload a copy/picture/screenshot of your payment, showing clearly your Name, Amount and Date paid. Thank you!
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Upload Copy of Receipt
Cancelof
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Please indicate your preference of location for pick-up of Membership sticker:* This field is required.(Upon approval of application, you will be contacted when the sticker is ready for collection)
EAST - Trincity Mall (Ferreira Optical)
WEST - Long circular Mall (Ferreira Optical)
CENTRAL - Price Plaza (Ferreira Optical)
SOUTH - Duncan Village (Visionary Eye care Providers)
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Is there anything else you would like us to know in considering your application?Include any relevant information if necessary.
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Thank you for your submission! We will be in touch. Please feel free to contact us at ttoptoma@gmail.com to check the status of your application. Follow us on Facebook & Instagram for regular updates.
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