Payment for Fellowship Application

Please enter information on this form to make payment for Fellowship Application


PUBLICATIONS AND LECTURES:


SPECIAL CATEGORY CANDIDATE: This section may include educators, clinical consultants, admins, ancillary personnel, affiliated professionals, & others who are distinguished by their contribution to the science of nutrition.


MEMBERSHIP AFFILIATIONS AND ACTIVITIES:


DISCIPLINARY HISTORY:

If the answer is “yes” to any Disciplinary History questions, a full explanation must be attached about the nature of the action or charge and the outcome.

Have you been convicted, found guilty, pleaded nolo contendere, received probation
without verdict, or received any other disposition (excluding acquittal or dismissal)
with respect to any criminal offense, including any drug law
DWI/DUI but excluding other traffic violations, or do you have any criminal
charges pending and unresolved in any local, state or federal court?
Have you ever been named as a defendant in any litigation or arbitration:


MEMBERSHIP PLEDGE

Realizing that the OWNS was formed in order to advance the science of nutrition for improved ocular health, I pledge myself as a condition of membership in the Ocular Wellness & Nutrition Society to support the following Standards of Conduct:

1) Members of the OWNS shall be of good moral character and maintain the highest standards of the profession;

2) Members of the Society shall accept responsibility for the consequences of their acts, make every effort to ensure that their services are used appropriately and when indicated, recommend alternative sources of care, if necessary;

3) Members of the Society shall maintain the highest degree of professional competence by rendering services, using techniques and providing opinions that meet the highest standards of practice;

4) The moral, ethical and legal standards of behavior of a member are a personal matter to the same degree as they are for any other citizen, except as they may compromise the fulfillment of the member’s professional responsibilities;

5) The professional standards of members of the Society require that public statements, announcements and promotional activities shall not be deceptive, fraudulent or misleading;


CANDIDATE DUES AND APPLICATION FEES:

Candidates for Fellowship are members of the OWNS & are required to maintain membership by paying annual dues. Recent graduates, military, educator, & affiliate members pay a reduced amount. The application fee is due when the application is submitted.


APPLICATION FEE:

All candidates are required to pay an application fee of $75.
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OWNS

 

OCULAR WELLNESS & NUTRITION SOCIETY
PO BOX 63
Cheyenne, WY 82003
307-264-2878 (office)
866-703-7229 (toll free office)
866-842-7270 (fax)