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Home
Membership
— Join LAEPS
— Membership Applications
—— Online Application
— Membership Services
— Upcoming Events & Education Meetings
— Renew Membership
Eye Health
— What is an Ophthalmologist?
— Eye Smart Monthly Update
— EyeCare America
Advocacy
— LA Legislative Session
—— Legislation Tracker
—— Capitol Contact Info
— Find Your Legislators
— Quick Links & Resources
About Us
— Our Mission and Goal
— LAEPS Leadership
Contact Us
LAEPS Membership Renewal
Personal Information
First Name
*
Last Name
*
Primary Office / Practice / Institution Name
Address
City
State
Zip
Email
*
Phone
*
Practice Administrator
Practice Administrator Email
Membership Type and Dues
Membership Dues Amount
*
Active Member Dues $600
2nd Year New Physician $300
1st Year New Physician No Charge
Ophthalmology Residents No Charge
Ophthalmology Fellows No Charge
Retired No Charge
Donation Amount: (WITHOUT dollar sign)
Comment
Payment Information
Total Amount
$
Payment method
*
Credit or Debit Card
Pay by check.
Please mail to:
LAEPS, P.O. Box 80053, Baton Rouge, LA 70898-0053
Credit Card Number
*
Expiration Date
*
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Card (CVV) Code
*
Card Type
*
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Card Holder Name
*
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