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AFOS Grand Rounds Interest Form
Thank you for your interest in participating as a Grand Rounds speaker for the 2021 AFOS SECO Meeting in Atlanta, GA on April 26-27!
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* Indicates required question
Name
*
Your answer
Email address
*
Your answer
Service Affiliation
*
Choose
Air Force
Army
Navy
Reservist or ANG
VA
PHS
IHS
Select the category that most accurately reflects your current status
*
Choose
Active Duty Military/Uniformed IHS
Civilian (GS/Contractor)
National Guard/Reserve (and NOT a full time DOD/VA/IHS civilian)
Retired Military (and NOT a full time DOD/VA/IHS civilian)
Title of your case
*
Your answer
Short description or abstract of your case (less than 500 words)
*
Your answer
What COPE category best describes your case?
*
Choose
Contact Lenses (CL)
Functional Vision/Pediatrics (FV)
General Optometry (GO)
Low Vision/Vision Impairment & Rehabilitation (LV)
Public Health (PB)
Glaucoma (GL)
Injection Skills (IS)
Laser Procedures (LP)
Peri-Operative Management of Ophthalmic Surgery (PO)
Refractive Surgery Management (RS)
Surgery Procedures (Optometric) (SP)
Treatment & Management of Ocular Disease: Anterior Segment (AS)
Treatment & Management of Ocular Disease: Posterior Segment (PS)
Neuro-Optometry (NO)
Oral Pharmaceuticals (OP)
Pharmacology (PH)
Principles of Diagnosis (PD)
Systemic/Ocular Disease (SD)
Ethics/Jurisprudence (EJ)
Practice Management (PM)
My Presentation Contains (select all that apply)
*
Pictures
Videos
Other:
Required
If selected to present, I can commit to attending AFOS SECO 2021 meeting in Atlanta (April 26-27, 2021)
*
Yes
No
Other:
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