Navigate this Section Select Eye Bank MembershipApplication For Membership Type of Membership RequestedType of Membership Requested Associate (Unaccredited) US Membership Associate (Unaccredited) International Membership Categories of Membership Note: Initial application must be for Associate (Unaccredited) Membership. Accreditation is a separate process. For more information on EBAA Accreditation, visit here. For information about membership dues, contact Kevin Corcoran, President and CEO.Legal Name of Eye BankLegal Name of Eye Bank Date/Place of IncorporationDate/Place of Incorporation Other Names/IDs Under Which the Eye Bank OperatesOther Names/IDs Under Which the Eye Bank Operates Eye Bank AddressEye Bank Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code COUNTRYAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Eye Bank PhoneEye Bank PhoneEye Bank FaxEye Bank FaxMain Contact EmailMain Contact Email Web AddressWeb Address Date of Incorporation or FoundingDate of Incorporation or Founding How is the eye bank funded? Check all that apply:How is the eye bank funded? Check all that apply: Processing Fees Charitable Public Support Government Funding Other If Other, Please SpecifyIf Other, Please Specify Is the organization a not-for-profit?Is the organization a not-for-profit? Yes No Attach a copy of the 501(c)(3) or 501(c)(6) tax-exempt status letter or a letter of determination.Accepted file types: pdf, doc, png, jpg, Max. file size: 50 MB.How is the organization controlled or governed?How is the organization controlled or governed?Non-profit CorporationPart of a larger organization (university, hospital, etc.If part of a larger organization, please specify:If part of a larger organization, please specify: Does the eye bank have a Board of Directors?Does the eye bank have a Board of Directors? Yes No If yes, please attach a list of the organization's Board of Directors or other individuals responsible for governance.Max. file size: 50 MB.Name of Medical DirectorName of Medical Director Attach a copy of the Medical Director's license and curriculum vitae.Max. file size: 50 MB.Executive DirectorExecutive Director Attach a copy of the Executive Director's current curriculum vitae or resume.Max. file size: 50 MB.Attach a copy of the eye bank's latest annual report or other documentation summarizing organizational performance and community benefit and any relevant public information materials (newsletter articles, brochures, etc.)Max. file size: 50 MB.Additional attachment:Max. file size: 50 MB.Additional attachment 2:Max. file size: 50 MB.Functions Performed:Functions Performed: Recovery Processing Tissue Storage Final Distribution Tissue Evaluation Donor Eligibility Determination Other If your eye bank performs other functions, please specifyIf your eye bank performs other functions, please specify Please provide statistic for the previous year, beginning on January 1 and ending on December 31. Count only those eyes/corneas recovered locally by your eye bank.Total number of corneas recovered by eye bankTotal number of corneas recovered by eye bank Number of corneas used for surgeryNumber of corneas used for surgery Number of corneas used for research/trainingNumber of corneas used for research/training Number of corneas discardedNumber of corneas discarded Please attach 1-3 letters of support and recommendation from related medical or health service organizations (e.g. local ophthalmologic society, US eye bank with which you have worked, etc.).Max. file size: 50 MB.Max. file size: 50 MB.Max. file size: 50 MB.Are you a member of any other professional organizations?Are you a member of any other professional organizations? Yes No IF YES, PLEASE LIST Please attach a letter signed by the eye bank's Board President (head of governing body); physician Medical Director and Executive Director (or head of staff) confirming the group's intent to pursue EBAA Membership:Max. file size: 50 MB.I have read, will our eye bank will comply with, EBAA’s Principles of Professional Conduct*I have read, and our eye bank will comply with, EBAA's Principles of Professional Conduct. By checking this box, I agree. A $100 application fee must accompany all membership applications. This fee can be submitted via check payable to the Eye Bank Association of America, 1101 17th Street, NW, Suite 400, Washington, DC 20036. Or follow this link to pay the membership application fee online. Applications are reviewed by the Constitution & Bylaws Committee and put forward to the Board of Directors for approval. The Constitution & Bylaws Committee reserves the right to request additional information during its review process. Please allow 60-90 days for the application approval process. Please contact Kevin Corcoran, President and CEO, with any questions about EBAA Membership or the membership application process. Eye Bank MembershipApplication For Membership
