Application For Membership

Membership Application

  • Type of Membership Requested
  • 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 Bank
  • Date/Place of Incorporation
  • Other Names/IDs Under Which the Eye Bank Operates
  • Eye Bank Address
  • Eye Bank Phone
  • Eye Bank Fax
  • Main Contact Email
  • Web Address
  • Date of Incorporation or Founding
  • How is the eye bank funded? Check all that apply:
  • If Other, Please Specify
  • Is the organization a not-for-profit?

  • 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.
  • How is the organization controlled or governed?
  • If part of a larger organization, please specify:
  • Does the eye bank have a Board of Directors?
  • If yes, please attach a list of the organization's Board of Directors or other individuals responsible for governance.

  • Name of Medical Director

  • Attach a copy of the Medical Director's license and curriculum vitae.

  • Executive Director

  • Attach a copy of the Executive Director's current curriculum vitae or resume.

  • 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.)

  • Additional attachment:

  • Additional attachment 2:

  • Functions Performed:
  • If 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 bank
  • Number of corneas used for surgery
  • Number of corneas used for research/training
  • Number 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.).

  • Are you a member of any other professional organizations?

  • 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:

  • I have read, and our eye bank will comply with, EBAA's Principles of Professional Conduct.

  • 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.