{"id":82427,"date":"2021-09-21T14:58:49","date_gmt":"2021-09-21T14:58:49","guid":{"rendered":"https:\/\/euretina.org\/?page_id=82427"},"modified":"2023-05-23T15:14:59","modified_gmt":"2023-05-23T15:14:59","slug":"national-society-application-form","status":"publish","type":"page","link":"https:\/\/euretina.org\/membership\/national-society-application-form\/","title":{"rendered":"National Society Application Form"},"content":{"rendered":"\n\n  <div class=\"banner has-hover has-parallax\" id=\"banner-821371956\">\n          <div class=\"banner-inner fill\">\n        <div class=\"banner-bg fill\" data-parallax=\"-3\" data-parallax-container=\".banner\" data-parallax-background>\n            <div class=\"bg fill bg-fill \"><\/div>\n                                    \n                    <\/div>\n\t\t\n        <div class=\"banner-layers container\">\n            <div class=\"fill banner-link\"><\/div>            \n\n   <div id=\"text-box-1394419055\" class=\"text-box banner-layer x50 md-x5 lg-x10 y85 md-y80 lg-y75 res-text\">\n                                <div class=\"text-box-content text dark\">\n              \n              <div class=\"text-inner text-center\">\n                  \n\n\t<div id=\"text-708081422\" class=\"text Hero-h1\">\n\t\t\n\n<h1>National Society Discount<\/h1>\n<p>Get 20% off as a member of a valid national society<\/p>\n\t\t\n<style>\n#text-708081422 {\n  font-size: 1rem;\n  text-align: left;\n}\n<\/style>\n\t<\/div>\n\t\n\n              <\/div>\n           <\/div>\n                            \n<style>\n#text-box-1394419055 {\n  width: 86%;\n}\n#text-box-1394419055 .text-box-content {\n  font-size: 100%;\n}\n@media (min-width:550px) {\n  #text-box-1394419055 {\n    width: 51%;\n  }\n}\n<\/style>\n    <\/div>\n \n\n        <\/div>\n      <\/div>\n\n            \n<style>\n#banner-821371956 {\n  padding-top: 300px;\n}\n#banner-821371956 .bg.bg-loaded {\n  background-image: url(https:\/\/d2jcwvonf1bqhq.cloudfront.net\/wp-content\/uploads\/2020\/12\/01112844\/Membership-hero-1400x795.png);\n}\n#banner-821371956 .bg {\n  background-position: 99% 63%;\n}\n@media (min-width:550px) {\n  #banner-821371956 {\n    padding-top: 300px;\n  }\n}\n@media (min-width:850px) {\n  #banner-821371956 {\n    padding-top: 400px;\n  }\n}\n<\/style>\n  <\/div>\n\n\n\t<div id=\"gap-119155381\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-119155381 {\n  padding-top: 50px;\n}\n<\/style>\n\t<\/div>\n\t\n\n\t<section class=\"section\" id=\"section_1234608683\">\n\t\t<div class=\"bg section-bg fill bg-fill  bg-loaded\" >\n\n\t\t\t\n\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\n\n<div class=\"row align-center\"  id=\"row-1767532398\">\n\n\n\t<div id=\"col-612715161\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner text-center\"  >\n\t\t\t\n\t\t\t\n\n<h3 style=\"text-align: center;\">National Society Application<\/h3>\n<p style=\"text-align: center;\">\u20ac120 for 1 year \/ \u20ac280 for 3 years<\/p>\n<p><span data-preserver-spaces=\"true\">If you are a member of one of our\u00a0<\/span><a class=\"editor-rtfLink\" href=\"https:\/\/euretina.org\/membership\/national-society-discount\/national-societies\/\" target=\"_blank\" rel=\"noopener\"><strong><span data-preserver-spaces=\"true\">listed national retina societies<\/span><\/strong><\/a><span data-preserver-spaces=\"true\">, you are eligible for a 20% discount on the standard membership fees. <\/span>Discounted fees are <span data-preserver-spaces=\"true\">\u20ac<\/span>120 for 1 year (<span data-preserver-spaces=\"true\">\u20ac<\/span>150 standard) and <span data-preserver-spaces=\"true\">\u20ac<\/span>280 for 3 year (<span data-preserver-spaces=\"true\">\u20ac<\/span>350 standard) membership packages.<\/p>\n<p><span data-preserver-spaces=\"true\">To qualify for this discount, you will need to provide verification of your membership with the national society by providing either a copy of your society membership certificate OR a receipt showing proof of your society membership fee payment.\u00a0<\/span><\/p>\n<p><span data-preserver-spaces=\"true\">Please go ahead and complete the form below. We will then be in touch with further instructions about if your application has been accepted. If your application is accepted, you&#8217;ll be given a one-time payment discount code to use at check out to claim your 20% national society discount.\u00a0<\/span><\/p>\n<p><span data-preserver-spaces=\"true\">If your national society is not listed and you would like it to be considered for inclusion, please email membership@euretina.org with your request.\u00a0\u00a0<\/span><\/p>\n<p><span data-preserver-spaces=\"true\">If you do not qualify for the National Society discount, please return to the\u00a0<\/span><a class=\"editor-rtfLink\" href=\"https:\/\/euretina.org\/membership\/\" target=\"_blank\" rel=\"noopener\"><strong><span data-preserver-spaces=\"true\">Membership Options<\/span><\/strong><\/a><span data-preserver-spaces=\"true\">\u00a0and select the right package for you.<\/span><\/p>\n\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n<\/div>\n\t<div id=\"gap-1407818474\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1407818474 {\n  padding-top: 50px;\n}\n<\/style>\n\t<\/div>\n\t\n\n<div class=\"row align-center .frm_style_euretina-form-style\"  id=\"row-999005513\">\n\n\n\t<div id=\"col-177551269\" class=\"col medium-10 small-12 large-10\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\n<div class=\"frm_forms  with_frm_style frm_style_euretina-form-style\" id=\"frm_form_21_container\" data-token=\"0947409e7ec09f15cc99a69720cd08cc\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_pro_form \" id=\"form_national-society-application\"  data-token=\"0947409e7ec09f15cc99a69720cd08cc\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">National Society Application<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"21\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_21\" id=\"frm_hide_fields_21\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"national-society-application\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_21\" name=\"frm_submit_entry_21\" value=\"14e35fd0cc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/82427\" \/><div id=\"frm_field_268_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half frm_capitalize\">\r\n    <label for=\"field_o69jd9a0947402f\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_o69jd9a0947402f\" name=\"item_meta[268]\" value=\"\"  data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_o69jd9a0947402f\"\/>\r\n    <div id=\"frm_desc_field_o69jd9a0947402f\" class=\"frm_description\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_269_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half frm_capitalize\">\r\n    <label for=\"field_l3dkca8aa6629bd\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_l3dkca8aa6629bd\" name=\"item_meta[269]\" value=\"\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_l3dkca8aa6629bd\"\/>\r\n    <div id=\"frm_desc_field_l3dkca8aa6629bd\" class=\"frm_description\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_full frm_half\">\r\n    <label for=\"field_xyrs9e142ced833\" class=\"frm_primary_label\">Primary Email Address (Username)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_xyrs9e142ced833\" name=\"item_meta[270]\" value=\"\"  data-reqmsg=\"Primary Email Address (Username) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email address is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_xyrs9e142ced833\"\/>\r\n    <div id=\"frm_desc_field_xyrs9e142ced833\" class=\"frm_description\">Enter Email<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_conf_270_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container  frm_full frm_half\">\r\n    <label for=\"field_conf_xyrs9e142ced833\" class=\"frm_conf_label frm_primary_label\">Confirm Primary Email Address (Username)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_conf_xyrs9e142ced833\" name=\"item_meta[conf_270]\" value=\"\"  data-reqmsg=\"Confirm Primary Email Address (Username) cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Email address is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_xyrs9e142ced833\"\/>\r\n    <div id=\"frm_desc_field_conf_xyrs9e142ced833\" class=\"frm_description\">Confirm Email<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1463_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_full frm_half\">\n    <label for=\"field_2go91\" id=\"field_2go91_label\" class=\"frm_primary_label\">Secondary Contact Email\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input type=\"email\" id=\"field_2go91\" name=\"item_meta[1463]\" value=\"\"  data-reqmsg=\"Secondary Contact Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_2go91\"\/>\n    <div class=\"frm_description\" id=\"frm_desc_field_2go91\">Enter Email<\/div>\n    \n<\/div>\n<div id=\"frm_field_conf_1463_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container  frm_full frm_half\">\n    <label for=\"field_conf_2go91\" id=\"field_conf_2go91_label\" class=\"frm_conf_label frm_primary_label\">Confirm Secondary Contact Email\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input type=\"email\" id=\"field_conf_2go91\" name=\"item_meta[conf_1463]\" value=\"\"  data-reqmsg=\"Confirm Secondary Contact Email cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_2go91\"\/>\n    <div class=\"frm_description\" id=\"frm_desc_field_conf_2go91\">Confirm Email<\/div>\n    \n<\/div>\n<div id=\"frm_field_272_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div  id=\"field_jwsatcffbca91a3_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_jwsatcffbca91a3_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_272-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_jwsatcffbca91a3_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_jwsatcffbca91a3_line1\" value=\"\" name=\"item_meta[272][line1]\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_272-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_jwsatcffbca91a3_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_jwsatcffbca91a3_line2\" value=\"\" name=\"item_meta[272][line2]\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_272-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_jwsatcffbca91a3_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_jwsatcffbca91a3_city\" value=\"\" name=\"item_meta[272][city]\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_272-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_jwsatcffbca91a3_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_jwsatcffbca91a3_state\" value=\"\" name=\"item_meta[272][state]\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_272-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_jwsatcffbca91a3_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_jwsatcffbca91a3_zip\" value=\"\" name=\"item_meta[272][zip]\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_272-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_jwsatcffbca91a3_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[272][country]\" id=\"field_jwsatcffbca91a3_country\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\">Afghanistan<\/option><option  value=\"Aland Islands\">Aland Islands<\/option><option  value=\"Albania\">Albania<\/option><option  value=\"Algeria\">Algeria<\/option><option  value=\"American Samoa\">American Samoa<\/option><option  value=\"Andorra\">Andorra<\/option><option  value=\"Angola\">Angola<\/option><option  value=\"Anguilla\">Anguilla<\/option><option  value=\"Antarctica\">Antarctica<\/option><option  value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option  value=\"Argentina\">Argentina<\/option><option  value=\"Armenia\">Armenia<\/option><option  value=\"Aruba\">Aruba<\/option><option  value=\"Australia\">Australia<\/option><option  value=\"Austria\">Austria<\/option><option  value=\"Azerbaijan\">Azerbaijan<\/option><option  value=\"Bahamas\">Bahamas<\/option><option  value=\"Bahrain\">Bahrain<\/option><option  value=\"Bangladesh\">Bangladesh<\/option><option  value=\"Barbados\">Barbados<\/option><option  value=\"Belarus\">Belarus<\/option><option  value=\"Belgium\">Belgium<\/option><option  value=\"Belize\">Belize<\/option><option  value=\"Benin\">Benin<\/option><option  value=\"Bermuda\">Bermuda<\/option><option  value=\"Bhutan\">Bhutan<\/option><option  value=\"Bolivia\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option  value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\">Botswana<\/option><option  value=\"Bouvet Island\">Bouvet Island<\/option><option  value=\"Brazil\">Brazil<\/option><option  value=\"British Indian Ocean Territory\">British Indian Ocean Territory<\/option><option  value=\"Brunei\">Brunei<\/option><option  value=\"Bulgaria\">Bulgaria<\/option><option  value=\"Burkina Faso\">Burkina Faso<\/option><option  value=\"Burundi\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/option><option  value=\"Cambodia\">Cambodia<\/option><option  value=\"Cameroon\">Cameroon<\/option><option  value=\"Canada\">Canada<\/option><option  value=\"Cape Verde\">Cape Verde<\/option><option  value=\"Cayman Islands\">Cayman Islands<\/option><option  value=\"Central African Republic\">Central African Republic<\/option><option  value=\"Chad\">Chad<\/option><option  value=\"Chile\">Chile<\/option><option  value=\"China\">China<\/option><option  value=\"Christmas Island\">Christmas Island<\/option><option  value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\">Colombia<\/option><option  value=\"Comoros\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook Islands\">Cook Islands<\/option><option  value=\"Costa Rica\">Costa Rica<\/option><option  value=\"Croatia\">Croatia<\/option><option  value=\"Cuba\">Cuba<\/option><option  value=\"Curacao\">Curacao<\/option><option  value=\"Cyprus\">Cyprus<\/option><option  value=\"Czech Republic\">Czech Republic<\/option><option  value=\"Denmark\">Denmark<\/option><option  value=\"Djibouti\">Djibouti<\/option><option  value=\"Dominica\">Dominica<\/option><option  value=\"Dominican Republic\">Dominican Republic<\/option><option  value=\"East Timor\">East Timor<\/option><option  value=\"Ecuador\">Ecuador<\/option><option  value=\"Egypt\">Egypt<\/option><option  value=\"El Salvador\">El Salvador<\/option><option  value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option  value=\"Eritrea\">Eritrea<\/option><option  value=\"Estonia\">Estonia<\/option><option  value=\"Ethiopia\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option  value=\"Faroe Islands\">Faroe Islands<\/option><option  value=\"Fiji\">Fiji<\/option><option  value=\"Finland\">Finland<\/option><option  value=\"France\">France<\/option><option  value=\"French Guiana\">French Guiana<\/option><option  value=\"French Polynesia\">French Polynesia<\/option><option  value=\"French Southern Territories\">French Southern Territories<\/option><option  value=\"Gabon\">Gabon<\/option><option  value=\"Gambia\">Gambia<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Germany\">Germany<\/option><option  value=\"Ghana\">Ghana<\/option><option  value=\"Gibraltar\">Gibraltar<\/option><option  value=\"Greece\">Greece<\/option><option  value=\"Greenland\">Greenland<\/option><option  value=\"Grenada\">Grenada<\/option><option  value=\"Guadeloupe\">Guadeloupe<\/option><option  value=\"Guam\">Guam<\/option><option  value=\"Guatemala\">Guatemala<\/option><option  value=\"Guernsey\">Guernsey<\/option><option  value=\"Guinea\">Guinea<\/option><option  value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option  value=\"Guyana\">Guyana<\/option><option  value=\"Haiti\">Haiti<\/option><option  value=\"Heard Island and McDonald Islands\">Heard Island and McDonald Islands<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\">Honduras<\/option><option  value=\"Hong Kong\">Hong Kong<\/option><option  value=\"Hungary\">Hungary<\/option><option  value=\"Iceland\">Iceland<\/option><option  value=\"India\">India<\/option><option  value=\"Indonesia\">Indonesia<\/option><option  value=\"Iran\">Iran<\/option><option  value=\"Iraq\">Iraq<\/option><option  value=\"Ireland\">Ireland<\/option><option  value=\"Isle of Man\">Isle of Man<\/option><option  value=\"Israel\">Israel<\/option><option  value=\"Italy\">Italy<\/option><option  value=\"Jamaica\">Jamaica<\/option><option  value=\"Japan\">Japan<\/option><option  value=\"Jersey\">Jersey<\/option><option  value=\"Jordan\">Jordan<\/option><option  value=\"Kazakhstan\">Kazakhstan<\/option><option  value=\"Kenya\">Kenya<\/option><option  value=\"Kiribati\">Kiribati<\/option><option  value=\"Kosovo\">Kosovo<\/option><option  value=\"Kuwait\">Kuwait<\/option><option  value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option  value=\"Laos\">Laos<\/option><option  value=\"Latvia\">Latvia<\/option><option  value=\"Lebanon\">Lebanon<\/option><option  value=\"Lesotho\">Lesotho<\/option><option  value=\"Liberia\">Liberia<\/option><option  value=\"Libya\">Libya<\/option><option  value=\"Liechtenstein\">Liechtenstein<\/option><option  value=\"Lithuania\">Lithuania<\/option><option  value=\"Luxembourg\">Luxembourg<\/option><option  value=\"Macao\">Macao<\/option><option  value=\"Macedonia\">Macedonia<\/option><option  value=\"Madagascar\">Madagascar<\/option><option  value=\"Malawi\">Malawi<\/option><option  value=\"Malaysia\">Malaysia<\/option><option  value=\"Maldives\">Maldives<\/option><option  value=\"Mali\">Mali<\/option><option  value=\"Malta\">Malta<\/option><option  value=\"Marshall Islands\">Marshall Islands<\/option><option  value=\"Martinique\">Martinique<\/option><option  value=\"Mauritania\">Mauritania<\/option><option  value=\"Mauritius\">Mauritius<\/option><option  value=\"Mayotte\">Mayotte<\/option><option  value=\"Mexico\">Mexico<\/option><option  value=\"Micronesia\">Micronesia<\/option><option  value=\"Moldova\">Moldova<\/option><option  value=\"Monaco\">Monaco<\/option><option  value=\"Mongolia\">Mongolia<\/option><option  value=\"Montenegro\">Montenegro<\/option><option  value=\"Montserrat\">Montserrat<\/option><option  value=\"Morocco\">Morocco<\/option><option  value=\"Mozambique\">Mozambique<\/option><option  value=\"Myanmar\">Myanmar<\/option><option  value=\"Namibia\">Namibia<\/option><option  value=\"Nauru\">Nauru<\/option><option  value=\"Nepal\">Nepal<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"New Caledonia\">New Caledonia<\/option><option  value=\"New Zealand\">New Zealand<\/option><option  value=\"Nicaragua\">Nicaragua<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Nigeria\">Nigeria<\/option><option  value=\"Niue\">Niue<\/option><option  value=\"Norfolk Island\">Norfolk Island<\/option><option  value=\"North Korea\">North Korea<\/option><option  value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option  value=\"Norway\">Norway<\/option><option  value=\"Oman\">Oman<\/option><option  value=\"Pakistan\">Pakistan<\/option><option  value=\"Palau\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\">Panama<\/option><option  value=\"Papua New Guinea\">Papua New Guinea<\/option><option  value=\"Paraguay\">Paraguay<\/option><option  value=\"Peru\">Peru<\/option><option  value=\"Philippines\">Philippines<\/option><option  value=\"Pitcairn\">Pitcairn<\/option><option  value=\"Poland\">Poland<\/option><option  value=\"Portugal\">Portugal<\/option><option  value=\"Puerto Rico\">Puerto Rico<\/option><option  value=\"Qatar\">Qatar<\/option><option  value=\"Reunion\">Reunion<\/option><option  value=\"Romania\">Romania<\/option><option  value=\"Russia\">Russia<\/option><option  value=\"Rwanda\">Rwanda<\/option><option  value=\"Saint Barthelemy\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option  value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon<\/option><option  value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\">Samoa<\/option><option  value=\"San Marino\">San Marino<\/option><option  value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\">Saudi Arabia<\/option><option  value=\"Senegal\">Senegal<\/option><option  value=\"Serbia\">Serbia<\/option><option  value=\"Seychelles\">Seychelles<\/option><option  value=\"Sierra Leone\">Sierra Leone<\/option><option  value=\"Singapore\">Singapore<\/option><option  value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option  value=\"Slovakia\">Slovakia<\/option><option  value=\"Slovenia\">Slovenia<\/option><option  value=\"Solomon Islands\">Solomon Islands<\/option><option  value=\"Somalia\">Somalia<\/option><option  value=\"South Africa\">South Africa<\/option><option  value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/option><option  value=\"South Korea\">South Korea<\/option><option  value=\"South Sudan\">South Sudan<\/option><option  value=\"Spain\">Spain<\/option><option  value=\"Sri Lanka\">Sri Lanka<\/option><option  value=\"Sudan\">Sudan<\/option><option  value=\"Suriname\">Suriname<\/option><option  value=\"Svalbard and Jan Mayen\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\">Swaziland<\/option><option  value=\"Sweden\">Sweden<\/option><option  value=\"Switzerland\">Switzerland<\/option><option  value=\"Syria\">Syria<\/option><option  value=\"Taiwan\">Taiwan<\/option><option  value=\"Tajikistan\">Tajikistan<\/option><option  value=\"Tanzania\">Tanzania<\/option><option  value=\"Thailand\">Thailand<\/option><option  value=\"Timor-Leste\">Timor-Leste<\/option><option  value=\"Togo\">Togo<\/option><option  value=\"Tokelau\">Tokelau<\/option><option  value=\"Tonga\">Tonga<\/option><option  value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option  value=\"Tunisia\">Tunisia<\/option><option  value=\"Turkey\">Turkey<\/option><option  value=\"Turkmenistan\">Turkmenistan<\/option><option  value=\"Turks and Caicos Islands\">Turks and Caicos Islands<\/option><option  value=\"Tuvalu\">Tuvalu<\/option><option  value=\"Uganda\">Uganda<\/option><option  value=\"Ukraine\">Ukraine<\/option><option  value=\"United Arab Emirates\">United Arab Emirates<\/option><option  value=\"United Kingdom\">United Kingdom<\/option><option  value=\"United States\">United States<\/option><option  value=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\">Uruguay<\/option><option  value=\"Uzbekistan\">Uzbekistan<\/option><option  value=\"Vanuatu\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\">Venezuela<\/option><option  value=\"Vietnam\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Wallis and Futuna\">Wallis and Futuna<\/option><option  value=\"Western Sahara\">Western Sahara<\/option><option  value=\"Yemen\">Yemen<\/option><option  value=\"Zambia\">Zambia<\/option><option  value=\"Zimbabwe\">Zimbabwe<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_273_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_1abwjd16c6ef113\" class=\"frm_primary_label\">Password\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"password\" id=\"field_1abwjd16c6ef113\" name=\"item_meta[273]\" value=\"\"  data-reqmsg=\"Password cannot be blank.\" aria-required=\"true\" data-invmsg=\"Password is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_1abwjd16c6ef113\"\/>\r\n    <div id=\"frm_desc_field_1abwjd16c6ef113\" class=\"frm_description\">Enter Password<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_conf_273_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container  frm_half\">\r\n    <label for=\"field_conf_1abwjd16c6ef113\" class=\"frm_conf_label frm_primary_label\">Confirm Password\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"password\" id=\"field_conf_1abwjd16c6ef113\" name=\"item_meta[conf_273]\" value=\"\"  data-reqmsg=\"Confirm Password cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Password is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_1abwjd16c6ef113\"\/>\r\n    <div id=\"frm_desc_field_conf_1abwjd16c6ef113\" class=\"frm_description\">Confirm Password<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_274_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_1r5l54a86dc43df\" id=\"field_1r5l54a86dc43df_label\" class=\"frm_primary_label\">Gender: How do you identify?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[274]\" id=\"field_1r5l54a86dc43df\"  data-placeholder=\"Select one\"  placeholder=\"Select one\" data-reqmsg=\"Gender: How do you identify? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Gender: How do you identify? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">Select one<\/option><option  value=\"Man\">Man<\/option><option  value=\"Woman\">Woman<\/option><option  value=\"Non-Binary\">Non-Binary<\/option><option  value=\"Other\">Other<\/option><option  value=\"Prefer not to say\">Prefer not to say<\/option>\t<\/select>\n\t\r\n    <div class=\"frm_description\" id=\"frm_desc_field_1r5l54a86dc43df\">EURETINA is dedicated to diversity and inclusion within the society and its activities. As a result, we are seeking some demographic information to help us understand the gender balance of our membership and event faculties.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_279_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_other_container\">\r\n    <label for=\"field_xtxc6\" id=\"field_xtxc6_label\" class=\"frm_primary_label\">Please select your National Society \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[279]\" id=\"field_xtxc6\"  data-placeholder=\"Select option\"  placeholder=\"Select option\" data-reqmsg=\"Please select your National Society  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please select your National Society  is invalid\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">Select option<\/option><option  value=\"ACOREV (Colombia)\">ACOREV (Colombia)<\/option><option  value=\"APVRS (Asia-Pacific Vitreo-retina Society)\">APVRS (Asia-Pacific Vitreo-retina Society)<\/option><option  value=\"Austrian Ophthalmological Society\">Austrian Ophthalmological Society<\/option><option  value=\"AVRSSL (Association of Vitreo-retina specialists of Sri Lanka)\">AVRSSL (Association of Vitreo-retina specialists of Sri Lanka)<\/option><option  value=\"BEAVRS\">BEAVRS<\/option><option  value=\"Belgian Retina Soc (BRS)\">Belgian Retina Soc (BRS)<\/option><option  value=\"Czech VR Soc\">Czech VR Soc<\/option><option  value=\"EGVRS (Egypt)\">EGVRS (Egypt)<\/option><option  value=\"EOS (Estonian Society of Ophthalmology)\" class=\"frm_other_trigger\">EOS (Estonian Society of Ophthalmology)<\/option><option  value=\"German Retina Society\">German Retina Society<\/option><option  value=\"GVRS (Greek Vitreoretinal Society)\">GVRS (Greek Vitreoretinal Society)<\/option><option  value=\"Irish College of Ophthalmologists (ICO)\">Irish College of Ophthalmologists (ICO)<\/option><option  value=\"Israeli Ophthalmological Society (Israel)\">Israeli Ophthalmological Society (Israel)<\/option><option  value=\"JRVS (Japan)\">JRVS (Japan)<\/option><option  value=\"Lithuanian Ophthalmological Society\">Lithuanian Ophthalmological Society<\/option><option  value=\"Medical Retina Association of Pakistan (MRAP)\">Medical Retina Association of Pakistan (MRAP)<\/option><option  value=\"Mexican Retina Association\">Mexican Retina Association<\/option><option  value=\"Ophthalmological Society of Kenya\">Ophthalmological Society of Kenya<\/option><option  value=\"SARyV (Argentina)\">SARyV (Argentina)<\/option><option  value=\"SOS (Slovak Ophthalmological Society)\">SOS (Slovak Ophthalmological Society)<\/option><option  value=\"SAVRS (South African VR Society)\">SAVRS (South African VR Society)<\/option><option  value=\"SERV (Sociedad Espa\u00f1ola de Retina y V\u00edtreo)\">SERV (Sociedad Espa\u00f1ola de Retina y V\u00edtreo)<\/option><option  value=\"SPO (Portuguese Society of Ophthalmology)\">SPO (Portuguese Society of Ophthalmology)<\/option><option  value=\"Taiwan Retina Society\">Taiwan Retina Society<\/option><option  value=\"Turkish Ophthalmology Association\">Turkish Ophthalmology Association<\/option><option  value=\"Ukrainian Vitreoretinal Society (UVRS)\">Ukrainian Vitreoretinal Society (UVRS)<\/option><option  value=\"Vitreo-Retina Society of the Philippines (VRSP)\">Vitreo-Retina Society of the Philippines (VRSP)<\/option><option  value=\"VRSI (India)\">VRSI (India)<\/option>\t<\/select>\n\t<label for=\"field_xtxc6-otext\" class=\"frm_screen_reader frm_hidden\">Please select your National Society <\/label><input type=\"text\" id=\"field_xtxc6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][279]\" value=\"\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_276_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container vertical_radio\">\r\n    <div  id=\"field_x5jcz070fa0354c_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_x5jcz070fa0354c_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_276-0\"><label for=\"field_x5jcz070fa0354c-0\"><input type=\"checkbox\" name=\"item_meta[276][]\" id=\"field_x5jcz070fa0354c-0\" value=\"This site collects names, emails and other user information. I consent to the terms set forth in the Privacy Policy\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> This site collects names, emails and other user information. I consent to the terms set forth in the Privacy Policy<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_277_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_np04c3470c7e63l\" id=\"field_np04c3470c7e63l_label\" class=\"frm_primary_label\">Please attach verification of your current membership with your national society.  Accepted verification includes a copy of your current society membership certificate OR a receipt showing proof of your current society membership fee payment.\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-reqmsg=\"Please attach verification of your current membership with your national society.  Accepted verification includes a copy of your current society membership certificate OR a receipt showing proof of your current society membership fee payment. cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[277]\"  data-reqmsg=\"Please attach verification of your current membership with your national society.  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Accepted verification includes a copy of your current society membership certificate OR a receipt showing proof of your current society membership fee payment.. Drop a file here or click to upload. Maximum file size: 104.86MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Please attach verification of your current membership with your national society.  Accepted verification includes a copy of your current society membership certificate OR a receipt showing proof of your current society membership fee payment.. Upload file. Maximum file size: 104.86MB\">Upload file<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 104.86MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    <div class=\"frm_description\" id=\"frm_desc_field_np04c3470c7e63l\">Please attach a .jpg, .png, .gif, .pdf or .mpg image of a form of identification showing your date of birth which can verify that you are under 40 years of age. You can upload your passport, drivers license or national identity card. <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_636_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_4akkr_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_4akkr\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdYXecfAAAAADgSYQXS-0_Rvm6Yxap6LwDL55kB\" data-size=\"invisible\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" name=\"item_meta[278]\" id=\"field_zah2u5fb7ed9b68\" value=\"\" data-frmval=\"\"\/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__659ece82732bd\">\n\t\t\t\t<label for=\"frm_email_21\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_21\" type=\"text\" class=\"frm_verify\" name=\"frm__659ece82732bd\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"frm_register[email]\" value=\"270\"\/>\n<input type=\"hidden\" name=\"frm_register[username]\" value=\"-1\"\/>\n<input type=\"hidden\" name=\"frm_register[password]\" value=\"273\"\/>\n<input type=\"hidden\" name=\"frm_register[subsite_title]\" value=\"username\"\/>\n<input type=\"hidden\" name=\"frm_register[subsite_domain]\" value=\"blog_title\"\/>\n<input name=\"frm_state\" type=\"hidden\" value=\"ER71r92tbQYSGEnf4WFGsKg6pwMnDKSjVxebl2drng0j7Bd1MVDfmhppih6w20uv\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit Application<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-177551269 > .col-inner {\n  padding: 0px 0px 0px 20px;\n}\n<\/style>\n\t<\/div>\n\n\t\n\n<\/div>\n\n\t\t<\/div>\n\n\t\t\n<style>\n#section_1234608683 {\n  padding-top: 30px;\n  padding-bottom: 30px;\n  background-color: rgb(255,255,255);\n}\n<\/style>\n\t<\/section>\n\t\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":4754,"parent":3587,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-transparent-header-light.php","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/pages\/82427"}],"collection":[{"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/comments?post=82427"}],"version-history":[{"count":9,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/pages\/82427\/revisions"}],"predecessor-version":[{"id":129409,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/pages\/82427\/revisions\/129409"}],"up":[{"embeddable":true,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/pages\/3587"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/media\/4754"}],"wp:attachment":[{"href":"https:\/\/euretina.org\/wp-json\/wp\/v2\/media?parent=82427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}