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2017 Membership renewal

Your name, licence number and declaration are the only required fields
Changes (only) to Professional Data
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AMERICAN Society, not CSCH-OD!
I wish to renew my membership in CSCH-OD for 2017 and and by checking the following box state that the information CSCH-OD has sent me by e-mail or as corrected above is accurate and that I am a member in good standing with my regulatory college.
After you click on "OK" the PayPal options will present themselves, unless you have left out some required fields.