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* First Name:

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* Surname:

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* Country of residence:

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* Institution / workplace:

SECTION 1:

Criteria for the next 4 questions: these are for FIACLEs associated with an institution

Please go to the next SECTION TWO if these questions do not apply to you

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* I have developed and presented at least one lecture or workshop session to practitioners, and/or educators:

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* I have submitted and/or published the following journal article(s) or book chapter(s):

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* I have participated / attended the following conferences and attended the following lectures / scientific sessions

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* I have presented at an IACLE Meeting

SECTION 2:

Criteria for the next 3 questions:  FIACLEs not associated with an institution such as IACLE  Associate Members

Please go to the next SECTION 3 if these questions do not apply to you

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* I have developed and donated an educational resource to IACLE

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* I am actively involved in research activity related to contact lenses

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* Please list any other contact lens related activities:

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* SECTION 3:

We ask our members to voluntarily donate contact lens educational material(s) in electronic form (in all languages) to be made available in the "Member Donated Resources Library" in the member portal of our website.

Please confirm if you have something to donate

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* Please provide us with a short professional biography about yourself which will be appended to your donated material:

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* Please state your affiliates which will be appended to your donated material:

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* Further comments / additional feedback:

THANK YOU

T