IACLE MEMBERSHIP APPLICATION

    To qualify to be a member of IACLE you must meet all membership criteria.
    IACLE membership is held by eye care professionals who teach contact lens education, with two membership categories available (Full and Associate).

    Full Member: An individual is eligible to be a Full Member of the Corporation if the individual is significantly involved either part-time or full-time in the coordination, implementation and/or direction of the contact lens curriculum at a recognized teaching institution.

    If you do not qualify for Full Membership you may be eligible to apply for Associate Membership.

    Associate Member: An individual is eligible to be an Associate Member of the Corporation if the person is positively contributing to contact lens education, but not formally affiliated with a recognized institution (typically, within a private practice/company).

    PERSONAL INFORMATION

    TEACHING INFORMATION

    Do you teach contact lens education to students at a recognized teaching institute?

    If you do not teach students at a recognized teaching institution, do you teach contact lens education to colleagues/peers?

    YesNo

    Details of where you teach contact lens education

    Name of teaching institute/company:

    Name of department you work in:

    Your job/position title at your workplace (not your qualification):

    Frequency of teaching contact lens education:

    Number of hours you teach contact lens education:

    Each week:


    OR

    Each month:


    OR

    Each year:

    Details of the contact lens education that you currently provide:

    Please provide the name and email of the Head of the Optometry Department / or your direct supervisor who can verify your contact lens teaching (if applicable):


    PROFESSIONAL INFORMATION

    Select the category which best describes the workplace where you teach contact lens education:

    Other: (please specify)

    QUALIFICATION

    Please select one from the following list what bests describes your primary qualification:

    Other (please specify)

    Comment:

    MEMBERSHIP GOALS

    Please indicate how IACLE can help you and your institution/workplace improve your contact lens curriculum/teaching:

    What do you wish to gain by joining IACLE?

    MEMBERSHIP AGREEMENT

    By submitting this application, I acknowledge that the copyright pertaining to all IACLE programs and resources is owned and retained by IACLE. I agree to undertake to ensure that all IACLE resources, including, but not limited to, the IACLE Contact Lens Course (ICLC), Case Reports, Image Collections and Flash Cards, will be used only by me and students under my direct supervision.

    I further undertake to ensure that IACLE’s programs and resources will not be used outside of my institution/company, or by colleagues, without written permission from IACLE.

    I accept that any unauthorized copying, editing, and/or selling of these educational programs/resources or any part(s) thereof, is strictly prohibited and any infringement of IACLE’s copyright may result in legal action by IACLE against the offending party/parties.

    IACLE membership is valid from January to December. When membership renewal is not received by the payment deadline (31 December), from 1 January membership expires and benefits are lost (and renewal from February incurs a late fee). If you are unable to pay prior to the deadline and wish to maintain your membership, please inform your IACLE Representative in advance.

    Please see our website to read the full terms and conditions of membership.

    By paying the membership fee, I confirm that I will abide by the conditions of membership and I understand that failure to abide by these conditions may result in termination of my membership.

    Full name:

    Date: