Professional Friend Form

1 Start 2 Practice information 3 Preview 4 Complete

Optometrists 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 that my practice will be contacted to arrange payment of the Foundation's Professional Friend program annual membership of $220 ($200 + GST) *

Yes

I would like to find out more about the Professional Friend Program

Yes