Retina Sri Lanka - Membership SignUp Please Read Instructions Carefully Before Completing This Application Form Personal Details Name in full Institution / Dept Private Address Phone Fax Email Official Details Official Address Phone Fax Email Date of Graduation Membership Levels 1. Ordinary members Ophthalmologists who have completed a one year formal clinicalfellowship in vitreoretinal surgery.Board certified ophthalmologists in charge of vitreo retinal units.Ophthalmologists who are practicing as vitreo retinal surgeons for a maximum of 5 yrs. 2. Associate members MD / MS Ophthalmology, FRCS, FRACS, FCOphth or other equivalentdegree in Ophthalmology. 3. Affiliate members Trainees in MD Ophthalmology (Sri Lanka) Insert your Photo & Date Below. Photo Signature Date I hereby apply for admission as an Ordinary / Associate / Affiliate Member of the Association of Vitreo Retina Specialists of Sri Lanka and undertake to abide by the Memorandum and Articles of Association.