Join Today!
Contact Us
Annual Congress – Exhibitors
Member Login
Contribute to TOPAC

About Us
Leadership
Events
Online CE Courses
Members Only
TOPAC
Practice Opportunities

Membership Signup

If you'd like to register by mail, download the printable form to the right.

In making this application for membership in the TAOP, I hereby accept and pledge myself to uphold the constitution & by-lawsm and further to assist in carrying out the objectives of the Tennessee Association of Optometric Physicians.
Date
MEMBERSHIP INFORMATION
Type of application:*
- New membership
- Reinstate membership
- Transfer membership from another state
Enter the state you are transferring from:*
AOA ID Number:
First Name:*
Middle Name:
Last Name:*
Suffix:
Designations (O.D., Ph.D., etc.):
Maiden Name (if applicable):
Application Information
Enter referring TAOP member name, if applicable:
Membership type:*
- Student - Undergraduate
- Student - Postgraduate/Resident
- TAOP & AOA Membership - Practicing full-time (more than 3 days per week)
- Optometric Educator - Working full-time at a College of Optometry
- Partial Practice - working 16 hours or less per week
- Out of State - primary practice is located outside of Tennessee
- Retired with benefits - you must have been an AOA member for 1 year previously to qualify
Partial Practice type:*
- Working 1 day or less per week
- Working 1-2 days per week
- Working 2-3 days per week
Resident - list years enrolled in Residency program:*
Contact & Demographic Information
Home Address:*
Street Address City State ZIP Code
Phone*
Cell*
Email*
Primary Work Location Information
Business/Practice Name:*
Business/Practice Address:*
Street Address Address Line 2 City State ZIP Code
Phone:*
Website
Would you like your Business Information Listed in the Find-a-Doctor database on taoponline.org?*
- Yes - list name, business address, phone & website
- Yes - list name, business address & website
- No - do not list any information
Communications Preferences
Preferred Mailing Address:*
Preferred method of contact:*
- Mail
- Email
- Both
Personal & Demographic Info
Date of Birth:*
Gender*
- Male
- Female
- Choose not to disclose
Marital Status:*
- Single
- Married
- Divorced
- Widowed
- Partner
- Unknown
- Choose not to disclose
Name of Spouse/Partner:
Political Affiliation:*
- Democrat
- Republican
- Independent
- Libertarian
- Green
- Unknown
- Choose not to disclose
Hispanic/Latino origin?
- Yes
- No
Ethnicity*
- White
- Black/African American
- Asian
- Native American
- Alaska Native/Pacific Islander
- Choose not to disclose
MILITARY SERVICE
Branch:
- Army
- Air Force
- Marine Corps
- Coast Guard
- Navy
- National Guard
Status
- Active
- Inactive
- Reserves
- Retired
- Deactivated
OPTOMETRIC INFORMATION
City and state where you graduated high school*
Name of college where you received your undergraduate degree:*
Optometry School Attended:*
Year of graduation (or expected year of graduation for students):*
Year ORIGINAL license obtained:*
Enter the 4-digit year
Are you planning on doing a residency?*
- Yes
- No
List other states licensed in:
Self Employed:
- 1 doctor - not affiliated with regional/national company
- 2-4 doctors - not affiliated with regional/national company
- 5+ doctors - not affiliated with regional/national company
- Franchisee - 1 OD affiliated with regional/national company
- Franchisee - Multiple ODs affliliated with regional/national company
- Lessee - affiliated with regional/national company
- Independent Contractor
- Other Self-Employed
Employed by:
- Optometrist(s) not affiliated with regional/national company
- Optometrist(s) affiliated with regional/national company
- Ophthalmologist(s)
- HMO
- Hospital/Clinic/Other Multidisciplinary
- Regional/National Company
- Armed Forces/VA/USPHS/IHS
- Educational Institution
- Local/State/Federal Government
- Optical/Ophthalmic Manufacturer or Wholesaler
- Non-Optometry-Owned Independent Franchise/Optical
Mode of Practice: I wish to work in . . .
1st Choice
2nd Choice
Membership Dues
To view the complete dues schedule, click here.
Student - Undergraduate*
Price: $0.00
TAOP & AOA membership is free for undergraduate student
Student - Postgraduate/Resident*
Price: $70.00
TAOP Dues: $35.00 + AOA Dues: $35.00
A1 - License year 2017*
Price: $0.00
TAOP & AOA membership is free for the first year.
A2 - License year 2016 (10%)*
Price: $185.70
TAOP Dues: $93.10 + AOA Dues: $92.60
A3 - License year 2015 (20%)*
Price: $371.40
TAOP Dues: $186.20 + AOA Dues: $185.20
A4 - License year 2014 (50%)*
Price: $928.50
TAOP Dues: $465.50 + AOA Dues: $463.00
A5 - License year 2013 (75%)*
Price: $1,392.75
TAOP Dues: $698.25+ AOA Dues: $694.50
A6 - License year 2012 or before (100%)*
Price: $1,857.00
TAOP Dues: $931.00+ AOA Dues: $926.00
Optometric Educators (50%)*
Price: $928.50
Dues detail: TAOP $465.50+ AOA $463.00 PLEASE NOTE: This membership type requires verification of full-time employment at a College of Optometry. Additional paperwork will be mailed for completion.
Partial Practice (60%) - works 16 hours or less per week*
Price: $1,114.10
TAOP Dues: $558.50 + AOA Dues: $555.60
TAOP Out of State*
Price: $200.00
Primary practice must be located outside of TN to qualify for this membership level.
Retired - with benefits*
Price: $100.00
NOTE: You must have been an AOA member for 1 previous year to qualify.
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Our Sponsors

Macular Health - A Lunovus Company

Johnson & Johnson Vision Care

© Tennessee Association of Optometric Physicians