ASCRS Form

Real World Ophthalmology

We are so excited to welcome you! This form is to sign up for our upcoming events & to join our community (free). We are excited to welcome you to the largest growing network of young ophthalmologists!

*If you registered previously, you must use the same email address and phone number to update your info. The system only allows a phone number to be associated with one email address. If you receive an error message and need assistance, please do not hesitate to reach us at [email protected]

First Name

Last Name

Email Address

Phone Number (Text reminders may be sent for specific event sign ups. Standard messaging rates may apply).

Street Address

City

State or Province

Zipcode

Country

Social media handles esp if you entered one of our online giveaways (IG, FB, Twitter, LinkedIn or TikTok)

Current Position

Name of Residency Program

Year (or Expected Year) of Residency Completion

Type of Ophthalmology Fellowship

Ophthalmology Fellowship Institution

Year (or Expected Year) of Fellowship Completion

If applicable, please list the name of your practice/place of employment

Practice Type

Academia

Private Practice

Please select the number of years you have been in practice

0-5 Years

5-10 Years

10+ Years

Please select which-in person meetings you plan to attend in 2023

ARVO 2023 April 23-27: New Orleans

ASCRS 2023 May 5-8: San Diego

ESCRS 2023 Sept 8-12: Vienna

AAO 2023 Nov 3-6: San Francisco

I am not planning on attending any of these meetings (please list additional in person meetings you are attending below)

Do you want to attend the next in person RWO Event? RSVP now before spots run out! Please choose your widest availability (if one is full, we will invite you to the other) & our events tend to fill up fast!:

ASCRS Lunch Saturday

ASCRS Lunch Sunday

San Diego After Dark 2023

No, I'm sorry I cannot attend

How did you hear about us?

Did a friend refer you to us? Please give them credit below!

Suggestions? Comments? Let us know. We want to hear from YOU!