EyeCare America® Resident Volunteer Pledge Form

I am an ophthalmology resident, dedicated to giving back to my community through volunteerism. Once I become a practicing ophthalmologist, I pledge to enroll as an EyeCare America volunteer and understand EyeCare America will contact me after my graduation date. Questions? Email eyecareamerica@aao.org.

First Name: *This question is required.

Last Name: *This question is required.

School Email Address: *This question is required. This question requires a valid email address.

Personal Email Address: *This question is required. This question requires a valid email address.

AAO Member ID Number, if applicable:

Anticipated Graduation Date: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

I was encouraged to pledge by, if applicable: