Professional Friend Form - Ophthalmologists

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Ophthalmologists Professional Friend Expression of Interest / Application

Thank you for your interest in becoming a Macular Disease Foundation Australia Professional Friend. Please complete and submit this form. A Foundation staff member will contact you as soon as possible.

I wish to join the Professional Friend Program. I accept the Terms and Conditions [1] of the Program

Yes

I understand the Foundation will contact me to arrange payment of my annual Professional Friend membership of $220 ($200 + GST)

Yes

Please contact me to discuss the Professional Friend program

Yes