I, the Undersigned, MD

President: Dr. Guy Sallet Vice-President: Dr. Françoise Van Cauwenberge General Secretary: Dr. Bernard Mathys Treasurer: Prof. dr. Marie-José Tassignon SOBEVECO-BSCRS MEMBERSHIP Belgian Society of Cataract and Refractive Surgeons (BSCRS) Belgian Contact Lens Society of Ophthalmologists Recognised Professional Society General Secretary’s Office: Dr. B. Mathys, Av. Van Overbekelaan 166, 1083 Brussels

I, the undersigned, MD, ......

Address: ......

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 Wish to register as a working member of BSCRS-SOBEVECO: contribution 90 € This annual contribution includes: - Access to the scientific meetings organised by SOBEVECO-BSCRS, free or at a reduced rate - Membership of the European Contact Lens Society of Ophthalmologists (ECLSO) - Access to the “Members Only” zone of the BSCRS website

 Wish to register as a working member of BSCRS-SOBEVECO and ESCRS: contribution 190 € This annual contribution includes: - Access to the scientific meetings organised by SOBEVECO-BSCRS, free or at a reduced rate - Membership of the European Contact Lens Society of Ophthalmologists (ECLSO) - Access to the “Members Only” zone of the BSCRS website - Full membership of the European Society of Cataract and Refractive Surgeons (ESCRS): Access to ESCRS On Demand  Access to iLearn  Access to the CME accredcited online learning platform Reduced registration fees at ESCRS congresses  Subscription to the Journal of Cataract and Refractive Surgery  Online access to the Journal of Cataract and Refractive Surgery  Subscription to ESCRS EuroTimes  Bimonthly eTIMES bulletin  Voting rights  Access to “Members Only” area of the ESCRS website  Membership pack including Membership certificate, Membership card with password and access code for “Members Only” area of the website

I hereby officially declare to comply with the rules of the professional medical deontology.

Date: ...... Signature: ......

In order to validate your subscription the names (or stamps) and signatures of two supporting members are required:

......

Once your membership application has been accepted by the General Assembly, you will be invoiced by the Treasurer of the SOBEVECO-BSCRS.

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