By submitting this form, you are certifying that you are the individual named in the application and that the information contained herein is true and complete to the best of your knowledge. You are consenting to share your name, contact information, and optometric education information with members of the Manitoba Association of Optometrists (your date of birth will not be shared). If granted registration as an Student Associate member in the Manitoba Association of Optometrists, you are agreeing to comply with The Optometry Act and Regulation, and Manitoba Association of Optometrists' By-Laws and policies established thereunder, and to conduct yourself in accordance with the professional and ethical standards of the profession.

By submitting this form, you are certifying that you understand that Student Associate members shall not have the right to vote, or to practise optometry, or to hold office in the Association, AND that a Student Associate member shall not have the right to complete a clerkship/externship in Manitoba without registering as an Optometric Student (Clerkship/Externship) member as defined in the Regulation to The Optometry Act, AND that your Student Associate membership shall continue from year to year so long as you remain registered at an ACOE-accredited optometric institution and shall end on July 31 of the year in which your optometric education program is scheduled to conclude.