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AOA
Australian Orthopaedic Association
 

APPLICATION FOR ASSOCIATE 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?

Upload 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  

Referees

* First referee name  


I agree with AOA membership application terms and conditions.


Payment details

Application Fees $205.00
* Credit card type  
* Name on credit card  
* Credit card number  
* Credit card expiry    
* CCV