OVDRA Regional Affiliate Registration Form

Regional Affiliate Registration Form
Regional Affiliates help expand OVDRA's global mission by providing local leadership, education, and support.

Each Regional Affiliate will have a Regional Coordinator who serves as an ambassador for OVDRA in their region. They:
- Support local members
- Organize regional CE or study groups
- Assist with public awareness and translations
- Coordinate with optometry schools and the OVDRA Board
Coordinators serve 1-year terms, renewable for up to 5 years.

Please fill out the form below to register your regional affiliate. Ensure all required fields are completed accurately to facilitate review and approval.
Affiliate Name*
Region or Territory
Affiliate Description*
Description should include countries represented, defined area and more
Regional Coordinator Full Name*

First NameLast Name
Regional coordinator, are you a current FOVDR or FOVDR-A?

FOVDRFOVDR-A
Regional Coordinator Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Regional Coordinator Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member Listing - list all current members affiliated with the regional group. *
Additional Information
Please provide any additional information or special considerations related to the affiliate setup.
Should be Empty: