Complete the following form to register.
You may add/modify any section below later from your account.

NOTE: additions and changes to your contact information are used for Optometry's Career Center only. If you need to update your information for your AOA records, please contact AOA Member Records at 800/365-2219, or email addresschange@aoa.org.
CONTACT INFORMATION
* Required Fields
AOA Member ID :	Enter your AOA membership ID number to receive free access.
Are You a Doctor? :	No O.D. M.D. Ph.D.
First Name :	*
Middle Initial :
Last Name :	*
Company/Practice :	*
Address :	*
City :	*
State/Province :	No state/province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip Code : *
Country :	-- Select a country -- United States Canada *
Phone :	*
Fax :
Email :	*
Username :	*
Password :	*
PROVIDER PROFILE
Select if you want to have your company/practice name displayed with your postings or keep it confidential. You may update your selection later by updating your profile.
Company/Practice Name :	Show Confidential
Optional: Enter your company/practice profile and/or Web site address that will appear with your listing(s).
Company/Practice Profile :
Company/Practice Web Site : (Use http://)
	Affirmation Statement Any information you receive as a part of the OCC is intended only for your personal use. The OCC, by choice, declares and reaffirms a policy of complying with federal and state legislation and does not in any way discriminate in services to the public on the basis of age, race, gender, religion, creed, national origin, qualified handicap or veteran status. In accordance with the Equal Employment Opportunity laws, I agree that I will not discriminate against any person in connection with the OCC on the basis of age, race, gender, religion, creed national origin, qualified handicap or veteran status. I certify that the information included is an accurate representation of my professional status and experiences. Agree Disagree