MADO: Join Now!


In applying for membership in the Mississippi Association of Dispensing Opticians, I understand that approval of membership is at the discretion of the present Board of Directors, and if approved I have the duty to abide by all present and future rules and bylaw provisions of the association. Dues are currently $85 per year.
Reasons to join MADO
	Strength in Numbers Certification Education National Affiliation	Information Services Referrals Web Development Services More...

* Required fields
Personal Info:					Company Info:
Title:*					Company:*
First Name:*					Address:*
Last Name:*					City:*
Address:*					State:*
City:*					Zip:*
State:*					Phone:*
Zip:*					Fax:*
Phone:*					E-mail:*
Is the firm where you work a branch office? *
	Yes	No
If Yes, please give name and address of main office and title of a representative:
Company:*					Contact Name:
Address:*
City:*
State:*
Zip:*
If your firm is a partnership or corporation, give name, city, and state of partner(s) or Board of Directors and/or major stockholders? *
Name:*					City:*
State:*
Name:*					City:*
State:*
Name:*					City:*
State:*
In what capacity are you employed? *
	Sole Proprietor			Partner
	Employee			Office Manager
Other:*
Is the firm engaged in wholesale distribution only? *
	Yes		No
How long have you been a dispensing optician? *
	0-5 yrs
	5-10 yrs
	Over 10 yrs
Indicate certifications held:
	Chartered Certified ABO Optician Yes No Certificate #					Certified ABO Optician Yes No Certificate #
	Yes No Certified NCLE Optician Certificate #					Other Certification Certificate #
Give a brief resume of your education, training, and experience: *

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