PGY-4 APPLICATION

APPLY TO ATTEND THE 2027 EYEPRENTICE CATARACT, REFRACTIVE, CORNEA AND ANTERIOR SEGMENT SHOWCASE!

September 10-12th 2027
Boca Raton, Florida

Submission Form

Name

Address

Phone Number

Yes, it's okay to send me text messages including order confirmations, updates, event reminders, and event information. Message frequency varies. Message and data rates may apply. Reply HELP for help, STOP to cancel. View our terms of service & privacy policy.

Date of Birth

MD/DO

Residency Program

Anticipated Graduation Date

Year in Residency at the time of the Showcase

Application

Headshot

Browse

Letters of Recommendation

Browse

List any professional references we can contact

Tell us why you would like to attend the fellowship showcase

What is your vision for the next chapter of your journey in the field of ophthalmology?

How did you hear about the Eyeprentice Program?

List your Social Media Channels

Upload any supporting documents

Browse

2027 Eyeprentice Application Fee

$51.75

Complimentary ASCRS YES Membership

As part of the Eyeprentice program, eligible residents and fellows have the opportunity to receive complimentary ASCRS Young Eye Surgeons (YES) membership at no cost throughout residency and fellowship. Following training, ASCRS offers discounted membership for surgeons during their first five years in practice.

ASCRS YES membership is designed to support residents, fellows, and young ophthalmologists early in their careers and includes access to:

Clinical education and surgical resources
Educational videos, webinars, and roundtable discussions
Mentorship and networking with ophthalmologists and ASCRS leadership
Career development resources and advice
YES-specific programs, events, and educational opportunities
ASCRS Annual Meeting benefits and access to eligible member programs

Checkbox

Yes, I would like to opt in to complimentary ASCRS YES membership. By checking this box, I authorize Eyeprentice to share the information provided in my application that is necessary to establish and administer my ASCRS membership. I understand that ASCRS may contact me directly regarding my membership, member benefits, educational opportunities, events, and other ASCRS communications

Terms & Conditions

TERMS & CONDITIONS

Please read these Terms and Conditions carefully before applying for the Eyeprentice 2027 Cataract, Refractive, Cornea, and Anterior Segment Fellowship Showcase. By submitting an application, you agree to the following terms:

Application and Selection
Submission of an application does not guarantee selection for the Eyeprentice 2027 Cataract, Refractive, Cornea and Anterior Segment Fellowship Showcase. Applications will be reviewed by the selection committee, and only chosen candidates will be notified. An Application fee of $50 will be collected at the time of submission. Please note this application fee is non refundable.

Travel and Accommodation Coverage
Eyeprentice may assist with certain travel expenses for selected fellows attending the Eyeprentice 2027 Showcase. Any other expenses, including but not limited to meals, transportation, additional nights of accommodation, and personal expenses, are the sole responsibility of the participant.

Program Approval Requirement
Applicants are responsible for obtaining any necessary approvals from their residency program prior to attending the Eyeprentice 2027 Showcase. Eyeprentice will not be responsible for any consequences or actions taken by a program as a result of a participant’s attendance.

Attendance Requirements
Selected residents must attend all designated sessions and activities scheduled as part of the Eyeprentice 2027 Showcase. Full participation is expected to gain the intended benefits and fulfill the requirements of the fellowship application process.

Liability Waiver
Eyeprentice is not liable for any personal injury, loss, or damage incurred by participants during travel or attendance at the Eyeprentice 2027 Showcase. Participation in the showcase is at the individual’s own risk.

Code of Conduct
All participants are expected to maintain a high standard of professionalism and respect throughout the event. Eyeprentice reserves the right to remove any participant found violating this code, with no obligation to reimburse costs incurred.

Acceptance of Terms
By submitting an application, you acknowledge and agree to these terms and conditions. Failure to adhere to any of the above terms may result in forfeiture of benefits and participation privileges.

I, the undersigned, agree to the terms above.

Registration Summary:	Total
Registrants (x1)	$50.00
Processing & Fees Fees include credit card processing fees and third-party software fees	$4.33

Total

$54.33

Includes processing & fees

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Event Registration Software by RegFox