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First name
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (the Democratic Republic of the)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
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Equatorial Guinea
Eritrea
Estonia
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Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
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Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kuwait
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Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Details About You
Prefix (Dr., Mr., Mrs., Ms., etc.)
Degree (MD, PhD, etc.)
Birth Month and day (MM/DD)
Specialty
Choose...
Select One...
Ophthalmology
Optometry
Pediatrics
Neurology
Plastic Surgery
Dermatology
General Medicine/Family Practice
ENT
Other
Subspecialty
Select One...
Cornea/External
General Ophthalmology
Glaucoma
Neuro-Ophthalmology
Ocular Plastics
Oncology
Pathology
Pediatric Ophthalmology
Research
Retina
Uveitis
Other
Address Line 1
Address Line 2
City
Zip Code
Country
Choose...
Afghanistan - AF
Aland Islands - AX
Albania - AL
Algeria - DZ
American Samoa - AS
Andorra - AD
Angola - AO
Anguilla - AI
Antarctica - AQ
Antigua and Barbuda - AG
Argentina - AR
Armenia - AM
Aruba - AW
Australia - AU
Austria - AT
Azerbaijan - AZ
Bahamas - BS
Bahrain - BH
Bangladesh - BD
Barbados - BB
Belarus - BY
Belgium - BE
Belize - BZ
Benin - BJ
Bermuda - BM
Bhutan - BT
Bolivia - BO
Bonaire, Saint Eustatius and Saba - BQ
Bosnia and Herzegovina - BA
Botswana - BW
Bouvet Island - BV
Brazil - BR
British Indian Ocean Terr. - IO
British Virgin Islands - VG
Brunei Darussalam - BN
Bulgaria - BG
Burkina Faso - BF
Burundi - BI
Cambodia - KH
Cameroon - CM
Canada - CA
Cape Verde - CV
Cayman Islands - KY
Central African Republic - CF
Chad - TD
Chile - CL
China - CN
Christmas Island - CX
Cocos (Keeling) Islands - CC
Colombia - CO
Comoros - KM
Congo (Democratic Republic) - CD
Congo (Republic) - CG
Cook Islands - CK
Costa Rica - CR
Cote d'Ivoire - CI
Croatia - HR
Cuba - CU
Curaçao - CW
Cyprus - CY
Czech Republic - CZ
Denmark - DK
Djibouti - DJ
Dominica - DM
Dominican Republic - DO
Ecuador - EC
Egypt - EG
El Salvador - SV
England - GB1
Equatorial Guinea - GQ
Eritrea - ER
Estonia - EE
Ethiopia - ET
Falkland Islands (Malvinas) - FK
Faroe Islands - FO
Fiji - FJ
Finland - FI
France - FR
French Guiana - GF
French Polynesia - PF
French Southern Territories - TF
Gabon - GA
Gambia - GM
Georgia - GE
Germany - DE
Ghana - GH
Gibraltar - GI
Greece - GR
Greenland - GL
Grenada - GD
Guadeloupe - GP
Guam - GU
Guatemala - GT
Guernsey - GG
Guinea - GN
Guinea-Bissau - GW
Guyana - GY
Haiti - HT
Heard & McDonald Islands - HM
Honduras - HN
Hong Kong (China) - HK
Hungary - HU
Iceland - IS
India - IN
Indonesia - ID
Iran - IR
Iraq - IQ
Ireland - IE
Isle of Man - IM
Israel - IL
Italy - IT
Jamaica - JM
Japan - JP
Jersey - JE
Jordan - JO
Kazakhstan - KZ
Kenya - KE
Kiribati - KI
Kosovo - KO
Kuwait - KW
Kyrgyzstan - KG
Laos - LA
Latvia - LV
Lebanon - LB
Lesotho - LS
Liberia - LR
Libya - LY
Liechtenstein - LI
Lithuania - LT
Luxembourg - LU
Macau (China) - MO
Madagascar - MG
Malawi - MW
Malaysia - MY
Maldives - MV
Mali - ML
Malta - MT
Marshall Islands - MH
Martinique - MQ
Mauritania - MR
Mauritius - MU
Mayotte - YT
Mexico - MX
Micronesia - FM
Moldova - MD
Monaco - MC
Mongolia - MN
Montenegro - ME
Montserrat - MS
Morocco - MA
Mozambique - MZ
Myanmar - MM
Namibia - NA
Nauru - NR
Nepal - NP
Netherlands - NL
Netherlands Antilles - AN
New Caledonia - NC
New Zealand - NZ
Nicaragua - NI
Niger - NE
Nigeria - NG
Niue - NU
Norfolk Island - NF
North Korea - KP
Northern Ireland - GB4
Northern Mariana Islands - MP
Norway - NO
Oman - OM
Pakistan - PK
Palau - PW
Palestine, State of - PS
Panama - PA
Papua New Guinea - PG
Paraguay - PY
Peru - PE
Philippines - PH
Pitcairn - PN
Poland - PL
Portugal - PT
Puerto Rico - PR
Qatar - QA
Republic of North Macedonia - MK
Reunion - RE
Romania - RO
Russian Federation - RU
Rwanda - RW
Saint Barthélemy - BL
Saint Helena - SH
Saint Kitts And Nevis - KN
Saint Lucia - LC
Saint Martin - MF
Saint Pierre and Miquelon - PM
Saint Vincent - VC
Samoa - WS
San Marino - SM
Sao Tome and Principe - ST
Saudi Arabia - SA
Scotland - GB2
Senegal - SN
Serbia - RS
Seychelles - SC
Sierra Leone - SL
Singapore - SG
Sint Maarten(Dutch part) - SX
Slovakia - SK
Slovenia - SI
Solomon Islands - SB
Somalia - SO
South Africa - ZA
South Georgia and the South Sandwich Islands - GS
South Korea - KR
South Sudan - SS
Spain - ES
Sri Lanka - LK
Sudan - SD
Suriname - SR
Svalbard And Jan Mayen - SJ
Swaziland - SZ
Sweden - SE
Switzerland - CH
Syria - SY
Taiwan (Republic of China) - TW
Tajikistan - TJ
Tanzania - TZ
Thailand - TH
Timor-Leste - TL
Togo - TG
Tokelau - TK
Tonga - TO
Trinidad and Tobago - TT
Tunisia - TN
Turkey - TR
Turkmenistan - TM
Turks and Caicos Islands - TC
Tuvalu - TV
U.S. Virgin Islands - VI
Uganda - UG
Ukraine - UA
United Arab Emirates - AE
United Kingdom - GB
United States Minor Outlying Islands - UM
Uruguay - UY
USA - US
Uzbekistan - UZ
Vanuatu - VU
Vatican City State (Holy See) - VA
Venezuela - VE
Vietnam - VN
Wales - GB3
Wallis and Futuna - WF
Western Sahara - EH
Yemen - YE
Zambia - ZM
Zimbabwe - ZW
State (if United States)
N/A -
Alabama - AL
Alaska - AK
Arizona - AZ
Arkansas - AR
California - CA
Colorado - CO
Connecticut - CT
Delaware - DE
District of Columbia - DC
Florida - FL
Georgia - GA
Hawaii - HI
Idaho - ID
Illinois - IL
Indiana - IN
Iowa - IA
Kansas - KS
Kentucky - KY
Louisiana - LA
Maine - ME
Maryland - MD
Massachusetts - MA
Michigan - MI
Minnesota - MN
Mississippi - MS
Missouri - MO
Montana - MT
Nebraska - NE
Nevada - NV
New Hampshire - NH
New Jersey - NJ
New Mexico - NM
New York - NY
North Carolina - NC
North Dakota - ND
Ohio - OH
Oklahoma - OK
Oregon - OR
Pennsylvania - PA
Rhode Island - RI
South Carolina - SC
South Dakota - SD
Tennessee - TN
Texas - TX
Utah - UT
Vermont - VT
Virginia - VA
Washington - WA
West Virginia - WV
Wisconsin - WI
Wyoming - WY
-- U.S. Territories --
American Samoa - AS
Guam - GU
Marshall Islands - MH
Micronesia - FM
Northern Mariana Islands - MP
Palau - PW
Puerto Rico - PR
Virgin Islands - VI
-- U.S. Armed Forces --
Armed Forces Americas - AA
Armed Forces Europe - AE
Armed Forces Pacific - AP
State (if NOT United States)
Company
Affiliated University
Professional Status
Choose...
Physician
Resident
Fellow
Optometrist
Nurse
Medical Student
Research / Scientist
Ophthalmic Tech
Other
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