2019 MOA Partner Program Registration

Complete the information below to support the profession of optometry through the MOA Partner Program.

Company Name:
Partnership Contact Person:
Email Address:
Company Address:
City: State: Zip:
Company Website:

Please choose your desired partnership level:

Collaborator - $10,000
Teammate - $7,000
Associate - $5,000
PLEASE NOTE: If your company requires additional paperwork, please let us know and we will happily comply with those requirements. Questions? Contact Jamie James, MOA Director of Communications & Marketing at jamie@themoa.org or call the MOA office at 517.482.0616.


If you would like to propose modifications to the Partner Program package you have selected, please detail the modification below and we will review and be in touch shortly.

Electronic Signature:

I agree to the terms, policies, conditions and rates set-forth by the Michigan Optometric Association.

   - denotes required fields