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All Registrants must be practicing or retired Ophthalmologists in the Tampa Bay Area

First Name:
Last Name:

FACS (Fellow American College of Surgeons)

Email Address:   This will function as your username for login purposes.

Global Password for Registration:

Your password will be encrypted

Password: Use only letters, numbers, and the underscore. Must be between 4 and 20 characters long.

Confirm Password: