Regn Appln

Australian Orthoptic Board - Registration Application

AOB Registration is biennial - current term 1 July 2021 to 30 June 2023
Application type*

NewRestore
Previous Registration no.
Registration expired
If within 2 years supporting documents NOT required unless requested
Name*

TitleFirst NameMiddle NameLast Name
Previous name/s
Address*

SuburbState

PostcodeCountry
Mailing address (if not as above)

SuburbState

PostcodeCountry
Personal email*

Confirmation Email
Alternate email

Confirmation Email
Mobile no.
Home no.

Area CodePhone Number
Work no.

Area CodePhone Number

QUALIFICATIONS

My academic orthoptic qualifications are:
Have you received your testamur*

YesNo
Month & Year course completed*
My eQuals link to testamur OR, if not yet conferred, to academic transcript
QUALIFICATION (1)*
Abbreviation
Institution*
Date conferred*
Upload copy of testamur

Upload a File
Optional Cancelof
QUALIFICATION (2)
Abbreviation
Institution
Date conferred
Upload copy of testamur

Upload a File
Optional Cancelof

EMPLOYMENT HISTORY

(If applicable)
When were you most recently employed in Orthoptics?*

Current
Over the past 3 years, how many years / months have you been employed in Orthoptics?*
Please provide a summary of orthoptic work undertaken in the past 5 years. (Date/duration, Employer, areas of practice.)*
Optional supporting documents (eg CV, references)

Upload a File

Cancelof
CPD Program

Participation in the CPD Program is compulsory.

Completion of 50 points of approved CPD activity in the 2-year registration period is required to be eligible to renew Registration.
DECLARATIONS
- I certify that the information and documents provided are true and correct.
- I acknowledge having received a copy of the Regulations adopted by the AOB.
- I undertake to inform myself of my responsibilities as an orthoptist registered by the AOB and abide by its Regulations (including the continuing professional development program of the AOB) while I am registered and in active practice.
- I understand that my registration is liable to be cancelled or I am liable to be disciplined in the event of breach of any of the requirements referred to in the Regulations.
- I undertake to provide any further information referred to in the Regulations and understand that if I refuse to provide any of the information this may affect my registration.
Required*

I agree to Declarations
Date*

DayMonthYear
(A copy of this form with further information will be emailed.)
Mailing address:

Australian Orthoptic Board
PO Box 1035
HAMPTON NORTH VIC 3188
APPLICATION - SIGNATURE
DECLARATION - SIGNATURE
Date*

DayMonthYear
Should be Empty:

Australian Orthoptic Board - Registration Application

CPD Program