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POLICY MANUAL OF THE ARIZONA
OPTOMETRIC ASSOCIATION

I. MEMBERSHIP - QUALIFICATIONS, ADMISSIONS AND DUES

A. ACTIVE MEMBERS

1. The criteria for securing and maintaining active membership in this association are as follows:

a. Must be an individual who has a Doctor of Optometry degree or college that has been accredited by the American College of Optometric Education (ACOE) or has been determined by the AOA to be an equivalent;

b. Adherence to the rules, regulations and restrictions imposed by the licensing body in Arizona;

c. Willingness to serve or otherwise participate as reasonably suggested by the Association, in activities relating to the Association, the practice of optometry;

d. Conduct the practice of optometry so as to avoid bringing discredit individually or collectively upon optometrists or optometry;

e. Pay all dues and assessments levied by this Association;

f. If employed, associated or otherwise involved in any way which directly or indirectly relates to the practice of optometry by or with any third party entity or person except on licensed to practice optometry in the state of Arizona, then ensuring that such involvement does not negatively affect the quality, scope, nature or extent of the optometry practice or services delivered;

g. Adhere to the Code of Ethics and Standards of Practice as described in Article VII in the By-Laws of the Arizona Optometric Association.

2. All applications for active membership shall be filed by the applicant with the Association office. Such applications will be referred to the Executive Director for approval or disapproval based on determination that the applicant is not in violation of AzOA and AOA Code of Ethics and Standard of Practice.

3. Payment Schedule - Dues for the Arizona Optometric Association are payable either annually, semiannually, quarterly or monthly as determined by the Board of Directors. In December of each year each member will receive a statement of his/her yearly dues along with a list of options for payment. Each member will select one of the following schedules and will return a specified form to the AzOA office no later than January 31st of that year. A) Annual dues payors: payment is due the first day of January and is payable within the first quarter; i.e. by March 31st. B) Semiannual dues payors: payment is due the first day of January and the first day of July and is payable within the first two months of each respective half; i.e. February and August. C) Quarterly dues payors: payment is due the first day of January and the first day of each quarter thereafter; i.e., April 1st, July 1st and October 1st. The quarterly payment is payable with the first month of each quarter. D) Monthly dues payors: payment is due the first day of each month.

B. FEDERAL SERVICE MEMBERS

1. The same criteria for securing and maintaining membership and method of application as applies to the Active Member category shall apply to this category.

2. Dues for Federal Service membership classifications shall be established by the Board of Directors.

C. PARTIAL PRACTICE MEMBERS

1. The same criteria for securing and maintaining membership and method of application as applies to the Active Member category shall apply to this category.

2. Dues for Partial Practice membership classification shall be established by the Board of Directors.

D. STUDENT MEMBERS

E. STUDENT MEMBERS

1. The same criteria for securing and maintaining membership and method of application as applies to the Active Member category shall apply to this category.

2. Dues for Out-of-State members classification shall be established by the Board of Directors.

F. LIFE MEMBERS

1. Eligibility for Consideration:

a. An optometrist who has been a direct member of this association for an extended period of time. Except where special circumstances exist, an extended period of time is considered to be 45 years of membership, of which 15 are uninterrupted.

b. A candidate must also meet at least one of the following criteria:

1) Fully retired

2) Part-time practice and at least age 65

3) Regardless of age or status of practice, if evidence of permanent incapacity is properly submitted in support of nomination.

c. Continuation of Life Membership status is contingent upon meeting the criteria of items 1a and 1b above. Pertaining to eligibility for consideration.

2. Life membership is based upon service and accomplishments. Nominations for Life membership shall be made in writing by a member in good standing of this Association and referred to the Board of Directors, and then submitted to the general membership for approval.

3. Life membership is effective as of the date of approval by the membership and not retroactive to the beginning of the calendar year in which the member was approved. A Life member shall pay dues and assessments as determined by the Board of Directors and ratified by adoption of the budget by the membership.

G. HONORARY MEMBERS

1. Nomination For Honorary membership shall be made in writing by a member in good standing of this Association to the President and referred to the Board of Directors for approval.

2. An Honorary member shall not be required to pay dues.

H. FRIENDS OF THE AZOA MEMBER

1. Criteria - Applicants for Friends of the AZOA membership in the Arizona Optometric Association shall, to the extent possible and reasonable:

a. Agree with the spirit and intent of the Code of Ethics and standard of Practice of the Arizona Optometric Association, including, but not limited to, those pertaining to false and misleading advertising and related conduct

b. Agree that neither they nor their employees are subject to consideration under any other membership categories.

c. Agree to pay all dues and assessments levied by the Association.

d. Agree to maintain maximum quality in all services and materials to be utilized in the delivery of vision care.

e. Agree to conduct their operation so as not to bring discredit upon the profession of optometry.

f. Understand that the Association Board of Directors shall annually review the status of all Associate members and whether they conform to the membership criteria.

g. Agree to do their share to solve problems facing vision care providers and their patients.

2. Rights and Privileges

a. Access to the Board of Directors when some action by the Board is deemed appropriate.

b. Subscription to any current or future publications of the Arizona Optometric Association.

c. Receive selected educational seminar, convention, and special function mailings.

d. Ten percent discount for advertising in any current or future publications of the AZOA.

e. Registration fee discount for exhibit space at conferences.

f. Recognition on the AZOA web site as Friends of the AZOA member.

3. The same criteria for securing and maintaining membership and method of application as applies to the Active Member category shall apply to this category.

4. The annual dues for Friends of the AZOA member shall be determined by the Board of Directors.

I. RETIRED MEMBERS

1. All optometrists applying for membership in this category shall make application directly to the AzOA, and upon approval of the Board of Directors and/or Executive Director shall become a Retired member.

2. Retired member applicants must:

a. Conform to all requirements set forth in the AzOA By-Laws, Article I, Section 1 - J.

b. Be a resident of the State of Arizona.

c. Pay all dues and assessments levied by the AzOA as set forth by the Board of Directors in Article X, Section 1 of the By-Laws.

3. Applicants need not meet any minimum age requirement.

I. OPTOMETRIC EDUCATOR MEMBERS

1. The same criteria for securing and maintaining membership and method of application as applies to the Active Member category shall apply to this category.

2. Dues for Optometric Educator member classification shall be established by the Board of Directors.

II. DUES AND ASSESSMENTS

Dues for each calendar year shall be determined by the Board of Directors and approved by adoption of the budget at any regular or special meeting of the Association.

Assessments shall be determined by the Board of Directors and approved by the general membership at any annual congress, meeting or special meeting called for such purpose.

A. SCHEDULE OF DUES AND ASSESSMENTS:

1. Active: AzOA dues of $795.00 plus full AOA dues plus 100% of assessments.

2. Federal Service: AzOA dues of $100.00 plus full AOA dues.

3. Partial Practice: 2 days or 16 hours or less per week is 60% of Annual dues.

4. Student: No dues.

5. Out-of-State: AzOA dues of $100.00.

6. Life: No dues. Request voluntary donation to Vision USA or OPACA.

7. Honorary: No dues.

8. Friends of the AZOA: $300 per year.

9. Retired: $100 per year to AzOA; $100 per year to AOA.

10. Optometric Educator: 50% of AZOA active member dues plus AOA dues of 50% of active member as indicated by AOA Bylaws.

B. ASCENDING DUES

An Active member shall not be required to pay any dues or assessments during the calendar year in which they first obtain their license to practice optometry. The dues and assessments for each of the first, second, third and fourth calendar year thereafter shall be equivalent to ten percent (10%), twenty percent (20%), fifty percent (50%) and seventy-five percent (75%) respectively, of the annual dues otherwise applicable.

C. PRO-RATING ASSESSMENTS

Assessments shall be pro-rated according to the ascending or descending scale for each membership category.

D. DUES REDUCTIONS

A member requesting a dues reduction must present to the Board in writing a summary of the individual’s circumstances that preclude them from meeting the obligation of payment of their dues.

Reductions in annual dues and assessments are not to exceed one-half of full dues and assessments where hardship on the member is demonstrated.

Under special circumstances, such as an unusual crisis that disrupts a member’s ability to remain in practice, the standard policy may be pre-empted and an AzOA dues waiver may be offered in any amount with annual review by the AzOA Board of Directors.

E. DELINQUENCY NOTICES

It is the policy of this Association that a notice be sent to all members delinquent in dues and or assessments, notifying them of the amount required to maintain membership and the procedure for future action.

Members are considered delinquent when in arrears for two quarters. A grace period of thirty days is allowed for payment before being dropped from membership and notifying AOA of same.

III. MEETINGS

A. SPRING AND FALL CONGRESS

1. There shall be a registration fee for the Spring and Fall Congress to be determined by the Congress Committee and approved by the AzOA Board of Directors. Student members will be required to pay a $20 registration fee.

2. Members in good standing shall be allowed to attend the AZOA business sessions

B.

The AZOA Board of directors shall choose the sites for Spring and Fall congresses. The Fall Congress may be held in any location in Arizona, preferably remote from a downtown area. Fall Congress locations outside of the State of Arizona can be considered with the approval of the membership at a regular meeting of the association.

C.

Notice of special meetings of the membership shall be sent electronically or sent via regular mail to members at least thirty (30) days prior to such meetings and shall state the purpose for which the meetings are called.

D. Congress Registration Refund Policy:

1. Full refunds will be granted to anyone who is not able to attend the congress due to a death or serious illness in the family.

2. Full refunds will be granted upon a request, which is received at least twenty (20) days prior to the first day of the congress.

3. Fifty percent (50%) refunds will be granted upon a request, which is received at least ten (10) days prior to the first day of the congress.

4. No refunds will be granted on requests, which are received less than ten (10) days prior to the first day of the congress.

5. Exhibitor registration refunds will be granted as follows:

a. Thirty (30) days prior - 100%

b. Twenty (20) days prior - 50%

c. No refunds will be granted on requests received less than 20 days prior to the first day of exhibits.

E. Continuing Education Certificates

2. The doctor’s registration will be verified and credited while the lecture is in progress by a designated AZOA officer.

IV. BOARD OF DIRECTORS/ELECTION OF OFFICERS

A.

There shall be four (4) At-Large Directors elected by the membership.

B.

Six (6) members of the Board of Directors shall constitute a quorum for the transaction of business.

C.

Executive Board shall consist of the following members only: President, President-Elect, Secretary, Treasurer and Immediate Past President.

D.

Election of officers shall be done by written ballot, if contested.

V. EXECUTIVE DIRECTOR

A.

The Board shall determine the compensation of the Executive Director and may, on behalf of the Association, enter into a contract with such Executive Director for a term not to exceed three (3) years; provided, however, that successive contracts may be entered into with the same person.

B.

The Executive Director shall administer the business and affairs and supervise the operation of the Association under the general guidance of the Board of Directors. He/She shall perform such duties as are ordinarily performed by persons in similar positions and such other duties as may from time to time be assigned to him/her by the Board of Directors

E.

Any Executive Director who works three (3) days a week or more shall be considered a full-time employee and eligible for any applicable benefits.

VI. RETIREMENT BENEFITS

A.

The AzOA has established a retirement plan for full-time employees.

B.

A 401K contribution based on a 100% match up to 3.75% of the employee’s annual salary.

VII. COMMITTEES

A. NOMINATING COMMITTEE

This Committee shall be appointed by the President and include the Immediate Past-President who shall serve as Chairperson, and three other AZOA members in good standing

The committee’s principal obligation is to select candidates based on personal qualification, demonstrated achievements, and potential service to the profession. The committee is responsible for providing information regarding the candidate’s qualifications and experience to the membership prior to the election. The committee shall prepare a slate of nominees for election to office in the AzOA which it shall present to the general membership at the annual spring AzOA Congress. The report of the nominating committee shall not preclude any member in good standing from making a nomination for any office from the floor at the Congress. Each nominee for office shall be invited to appear before the membership prior to the election at the Congress.

B. BUDGET AND FINANCE COMMITTEE

The Budget Committee shall consist of the President-Elect, who shall serve as Chairperson, and three (3) members, appointed by the President. The Budget Committee shall submit the proposed budget to the Board of Directors for ratification.

B. SPECIAL AND AD-HOC COMMITTEES

The President of this Association during the period of his/her administration shall establish and prescribe the functions and appoint the members of such special or ad-hoc committees, as he/she deems necessary or desirable for the effective operation of his Association.

VIII. CONFLICT OF INTEREST

A. No member of the Board of Directors, the Executive Board, the Executive Director, or any of its Committee Chairs shall derive any personal profit or gain, directly or indirectly, by reason of his or her participation with the Arizona Optometric Association. A Conflict of Interest form provided by the Arizona Optometric Association shall be completed and returned within 30 days of the close of the Annual Spring Congress by all of above parties.

IX. CODE OF ETHICS AND STANDARDS OF PRACTICE

A. CODE OF ETHICS

1. It shall be the duty of every optometrist to render the highest quality of vision care to all patients.

2. All confidences committed to the optometrists, as part of professional relationship with the patient, shall be kept inviolate, except when specifically released by the patient or as required by judicial process in the interest of justice.

3. It shall be the duty of every optometrist to explain the nature of any treatment given to the patient.

4. Every optometrist shall be ultimately responsible for the advice and treatment given to the patient. The optometrist shall inform the patient whenever referral is advisable to either another optometrist or to another health care professional.

B. STANDARDS OF PRACTICE

1. Members shall abide by the Arizona Optometry Law and by the rulings of the Arizona State Board of Optometry.

2. Members shall conduct their practice consistent with the professional standards of conduct of health professionals.

3. Members shall render the highest quality of care to all patients. Quality of patient care should include such tests as are necessary to determine the nature and extent of the problem, a careful presentation explaining the nature of the problem, and any advice and treatment given.

4. Members shall identify themselves professionally in one of the following manners:

a. Name, O.D.

b. Dr. Name, Optometrist

c. In such manner as is authorized by state law or board regulations for members of professional corporations.

B. ANTITRUST COMPLIANCE POLICY

It shall be the policy of the Arizona Optometric Association to be in strict compliance with all Federal and State Antitrust laws, rule and regulations. Therefore;

(1) No meeting of the members of AzOA, of the Board of Directors or any team (aka committee) of AzOA, shall include any formal or informal discussion of any of the following topics:

(a) Fees or prices charged or to be charged by any optometric physician for vision care services, for frames and lenses, for contact lenses or for any other ophthalmic services, devices or supplies;

(b) Prices paid or to be paid by any optometric physician for frames and lenses, for contact lenses or for any other ophthalmic services, devices or supplies;

(c) Joint or concerted action with respect to any supplier, insurance carrier, health

care service contractor or competitor, other than legal or legislative action;

(d) The advisability or inadvisability of agreeing to accept fees paid or to be paid by a

particular insurance carrier or health care service contractor;

(e) Joint or concerted action to allocate markets, to direct or control referrals, to impose

or accept limits on the sales volume, patients, employees or locations of any optometric physician, to exclude any person from membership in AzOA for any reason other than his or her failure to meet the qualifications for membership established in the bylaws, or to otherwise affect competition in the delivery of vision care services to the public.

(2) The mere fact that a particular subject is not expressly mentioned in paragraph (1) of this Policy does not necessarily mean that it can be discussed with impunity. Except for discussions about legal or legislative action, any discussion which has the purpose or effect of raising or stabilizing prices, or lowering or stabilizing costs, of limiting the ability of an insurance carrier or other person or entity to enter a market, or of otherwise affecting competition in any aspect of the vision care market, is illegal. Any discussion, which could reasonably be viewed as having any such purpose or effect, even if neither is intended, could very well be illegal.

(3) If there is any doubt as to whether a particular subject is covered by this policy, there shall be no discussion of it at any AzOA meeting except in accordance with the advice of, and any limitations established by, counsel for AzOA.

(4) If at any time during or in connection with an AzOA meeting, any discussion prohibited by this policy should occur, it shall be the responsibility of each member present to protest the discussion and, if it does not immediately cease, to remove him or herself from the discussion.

D. ADVERTISING GUIDELINES

It is the policy of the Arizona Optometric Association that the public should be provided with meaningful information on ophthalmic goods and services, to forbid any advertising that may be fraudulent or misleading, and to comply fully with all valid applicable state and federal laws and regulations.

X. SUSPENSION OR REVOCATION OF MEMBERSHIP

A. MECHANISM FOR HEARING

1. Upon receiving a complaint, the President shall appoint a committee of three (3) practicing optometrists, who are not AzOA Board members, to gather pertinent information on said case. The President will call a meeting of the Board for a hearing of the pertinent information.

2. In such cases, the Board shall send to such member, by registered mail, a statement of the charges against him/her and such member shall have fifteen (15) days after receipt thereof to respond to such charges by mailing a copy of his/her response, by registered mail, to the Secretary of this Association.

3. The Board shall thereafter hold a hearing at which such person or counsel be given reasonable opportunity to present evidence and to be heard in his/her own defense, and the Board may request other persons to testify at the hearing.

4. A secret ballot shall be taken; if disciplinary action is voted by a simple majority of this group, a reprimand, suspension or expulsion from membership shall at this point be voted by secret ballot. Such member may be suspended or expelled by a vote of three-fourths (3/4) of the full membership of the Board. The optometrist shall then be informed of the action taken by written notice.

B. APPEALS

1. Either the defendant or the complainant may appeal the findings of the Hearing Committee, and be present at the meeting of the Board of Directors considering those findings. The appeal must be in writing and be justified on the basis that proper procedure was not followed, that information not available at the time of the hearing has developed, or that a decision was made that, on the face of it, ran counter to the evidence and testimony presented.

B. REINSTATEMENT

1. Membership will be automatically reinstated upon completion of term of suspension.

2. Reinstatement of membership for non-payment of dues and/or assessments will be automatic upon payment of dues and/or assessments owed for the year in which the member was suspended and current dues and/or assessments payable.

3. If membership was revoked, a new application must be submitted, not less than 365 days from date of revocation.

4. No dues or assessments shall be refunded to, or credited to the account of, any person whose membership has been suspended or revoked.

XI. OUT-OF-STATE MEETINGS

A.

Authorized delegates to out-of-state meetings are to file a written report of the meeting and their reimbursement expenses with receipts attached within two weeks of the conclusion of the meeting.

B.

1. AOA Annual Congress: Meeting expenses for President, President-Elect and Vice President shall be reimbursed for attendance at AOA Annual Congress. Expenses shall include hotel accommodations booked in the official meeting room block, coach airfare, meeting registration fees, local transportation and a per diem of $50 to cover meals and incidentals.

2. GWCO/President’s Council/Other Leadership Conference: Meeting expenses for President, President-Elect and Vice President shall be reimbursed for attendance at GWCO, President’s Council or other Leadership Conferences as approved by the Board of Directors. Expenses shall include hotel accommodations booked in the official meeting room block, coach airfare, meeting registration fees, local transportation and a per diem of $50 to cover meals and incidentals. GWCO currently reimburses expenses for the AZOA President, provided that the mandatory attendance requirements are met. It is required that the President meet the attendance requirements in order to receive reimbursement from AZOA.

3. Other Travel: Meeting expenses for the Executive Director and one additional AZOA staff person shall be reimbursed for attendance at Vision Expo or any other AZOA related meeting as deemed appropriate and budget allowing. Expenses shall include hotel accommodations booked in the official meeting room block, coach airfare, meeting registration fees, local transportation and a per diem of $50 to cover meals and incidentals.

4. In order to be eligible for reimbursement, all flights related to AZOA business must be booked in coach class at least two weeks prior to each meeting, and hotel accommodations must be made in the official meeting room block.

5. If the President, President-Elect or Vice President is unable to attend a meeting, then the President may assign a representative (eligible for expense reimbursement) to attend in their place.

6. Personal vehicle use. The use of a personal vehicle to attend an authorized out-of-state meeting is permitted and the mileage will be reimbursed at the current IRS published rate. The total mileage reimbursement will not exceed the sum of the lowest available round trip coach airfare as determined by the AzOA office.

XII. LOCAL SOCIETIES

The following Societies have been approved by the Arizona Optometric Association Board of Directors:

A.

Southern Arizona Optometric Society.

XIII. AWARDS

A. OPTOMETRIST OF THE YEAR

1. Formation of Committee: This professional service award recognizes an individual for outstanding participation and contributions to organized optometry in his or her community. It is intended that this award be used to indicate one person whose cumulative service up to the time of presentation exemplifies the tradition of unselfish service for the betterment of his or her profession and community.

The award committee will be composed of the two most recent recipients (who are current AzOA members in good standing) and the AzOA President with the most recent recipient as Chairperson.

Nominations will be accepted from the general membership and the committee. Eligible nominees include any AZOA member in good standing. An AZOA member can only nominate one doctor per year. Nominations must be received by sixty days prior to the Spring Congress to be eligible. The committee shall poll all past recipients (who are current members in good standing) by mail or electronic ballot with distribution of nominee’s background and qualifications. Ballots shall be returned to the committee for tabulation. The award will be presented at the AzOA Spring Congress.

2. Nomination/Election process:

A. Nominators should attach any supporting materials and reasons why the nominee is worthy of the award.

B. Previous winner can be allowed to remove their names from consideration.

C. The winner shall be announced thirty (30) days prior to the Spring Congress.

3. Guidelines of Qualifications:

I. Contribution to Optometry

A. Participation on committee and positions or offices held in AzOA or affiliated optometric organizations (local, state, regional, and national).

B. Outstanding accomplishment in organized optometry for which the nominee was principally responsible.

II. Contribution to Community

A. Appointed or elected public offices held by nominee.

B. Activity in service clubs, civic groups, education, religious groups, or charitable programs.

III. Contributions to Health and Vision Welfare of the Public

A. Participation in vision related services such as public speaking, vision screening or public health.

B. Participation in community, county, or state vision or health care programs.

C. Legislative activities beneficial to the visual welfare of the public.

IV. Professional Development and Conduct

A. Academic and professional awards and honors.

B. Attendance at association meetings and education programs.

C. Current with policies of AzOA.

D. Membership in any other optometric organizations.

E. Professional articles or lectures given.

F. Practicing current state of the art optometry in a professional and ethical manner regardless of mode of practice.

B. PRESIDENT’S AWARD

The President’s Award is presented at the Spring Congress to an individual selected by the president who has served in this administration in a leadership role and has made an outstanding contribution to the profession by virtue of this service.

C. SIGHT CONSERVATION AWARD

Each year the AzOA Board recognizes an individual or company who has made a significant contribution to the preservation of sight through the promotion of projects and programs to eye care and related fields. The award will be presented at the Spring Congress.

D. YOUNG OD OF THE YEAR AWARD

1. Formation of Committee: This professional service award recognizes an individual for outstanding participation and contributions to organized optometry in his or her community. It is intended that this award be used to indicate one person whose cumulative service up to the time of presentation exemplifies the tradition of unselfish service for the betterment of his or her profession and community.

The award committee will be composed of the two most recent recipients (who are current AzOA members in good standing) and the AzOA President with the most recent recipient as Chairperson.

Nominations will be accepted from the general membership and the committee. Eligible nominees include any AzOA member in good standing in active optometric practice for less than ten years. Nominations must be received by sixty days prior to the Spring Congress to be eligible. The committee shall poll all past recipients (who are current members in good standing) by mail or electronic ballot with distribution of nominee’s background and qualifications. Ballots shall be returned to the committee for tabulation. The award will be presented at the AzOA Spring Congress.

2. Guidelines of Qualifications

I. Contribution to Optometry

A. Participation on committee and positions or offices held in AzOA or affiliated optometric organizations (local, state, regional, and national).

B. Outstanding accomplishment in organized optometry for which the nominee was principally responsible.

II. Contribution to Community

A. Appointed or elected public offices held by nominee.

B. Activity in service clubs, civic groups, education, religious groups, or charitable programs.

III. Contributions to Health and Vision Welfare of the Public

A. Participation in vision-related services such as public

speaking, vision screening or public health.

B. Participation in community, county, or state vision or health care programs.

C. Legislative activities beneficial to the visual welfare of the public.

IV. Professional Development and Conduct

A. Academic and professional awards and honors.

B. Attendance at association meetings and education programs.

C. Current with policies of AzOA.

D. Membership in any other optometric organizations.

E. Professional articles or lectures given.

F. Practicing current state of the art optometry in a professional and ethical manner regardless of mode of practice.

XIV. MISCELLANEOUS

A.

AzOA shall provide a minimum of sixteen (16) hours of Continuing Education annually.

B.

All recommendations to the Arizona State Board of Optometry and other agencies or Board shall be approved by the AzOA Board of Directors.

C.

A local society formed after 7/1/85 shall submit a constitution and by-laws to the Board of Directors for approval before being officially recognized. No requests will be considered without an initial minimum membership of eight (8) persons.

D.

Member E-mail/e-blast release

AZOA Friends of AZOA Members are entitled to a maximum of_______4_____ e blasts per year at no cost.

Additional e-blasts may be purchased at______$300.00_____each

Non AZOA associate members may request an e blast to our membership for a fee of____$500.00____each

Revised May 2004.

Revised July 2006

Revised May 2009

Revised June 2010

Revised November 2011

Revised November 2012

Revised April 2013

Revised November 2015

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