FY26 State Society Membership Application
Welcome to UOA! Please complete the required information and submit payment by August 1, 2025. Reach out to gcooper@opticians.org with any questions. Membership is valid through June 30, 2026
State Society Name
*
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
What is your position in this State Society?
*
Contact Phone Number
*
Please enter a valid phone number.
State Society Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you interested in participating in UOA committees?
*
Yes
No
Select the committees you are interested in. (Checking the box does not guarantee membership on any committee). Committees will be formed over the summer.
Conference
Education
Government Relations
Leadership
Marketing
Membership
Officer Contact Information & Society Administrators
President
*
First Name
Last Name
President Email
*
example@example.com
Vice President
*
First Name
Last Name
Vice President Email
*
example@example.com
Secretary
*
First Name
Last Name
Secretary Email
*
example@example.com
Treasurer
*
First Name
Last Name
Treasurer Email
*
example@example.com
Who should be listed as the State Society Administrator(s)? Please list no more than two people.
Payment Method:
Credit Card
Check
State Society Membership
Please choose the membership category corresponding to the number of current members in your State. Payment is due at time of application. State Membership is valid through June 30, 2026
Membership Type
0-50 Member State Society Membership
50-150 Member State Society Membership
151+ Member State Society Membership
UOA Membership Fee
Mail check to:
United Opticians Assocation
PO BOX 910130
Lexington, KY 40591
Membership Type
*
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( X )
0-50 Member State Society Membership
$
400.00
51-150 Member State Society Membership
$
1,000.00
151+ Member State Society Membership
$
1,500.00
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