Submit a Registration Please fill out the form below to complete your registration request *Email*Confirm Email*Password*Confirm Password*First Name*Last Name*ProfessionOphthalmologistOptometristNon-eyecare medical doctorGovernment employeeNon-government organization (NGO) employeeDrug/device industry employee*Primary Institution/Facility/Place of work Address 1Address 2CityState*CountryPostal code*PhoneFaxAvatar UploadDo you belong to a regional ophthalmology society?YesNoName of ophthalmology societyDo you belong to a regional glaucoma society?YesNoName of glaucoma societyYearly outpatient glaucoma patient volumeGlaucoma treatments available at your facility (check all that apply)ALTSLTMLTYAG iridotomyCyclophotocoagulationTrabeculectomyMitomycin CTube-shuntiStentXENOtherOther treatments at your facility
