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AOA
Australian Orthopaedic Association
 

APPLICATION FOR AFFILIATE MEMBERSHIP

Personal details

* Title
* First name  
Other name(s)
* Last name  
* Date of birth  
Marital status
Spouse's name

Passport photo

* Passport photo  

Home address

* Preferred address
* Address 1  
Address 2
* Suburb  
* State  
* Postcode  
* Country  

Practice address

* Preferred address
* Address 1  
Address 2
* Suburb  
* State  
* Postcode  
* Country  

Contact details

* Email  
** Work Phone   
** Home Phone   
** Mobile phone   
** Fax   

Professional qualifications

* Degrees and diplomas (with awarding institutions and names)
* Do you have FRACS or equivalent?
* If not, are you eligible to apply for FRACS?
What is your FRACS ID number?

Curriculum vitae

Attach curriculum vitae, which must include:

  • All appointments since graduation with dates, period, nature of duties and names of surgeons concerned
  • Nature of present professional practice
  • Titles and references of publications in orthopaedic surgery
 

Proposers

* Proposer's name    
* Seconder's name:    


I agree with AOA membership application terms and conditions.