Affiliate membership - AOA | Australian Orthopaedic Association

Personal details

* Title

* First name First name is Required

Other name(s)

* Last name Last name is Required

* Date of birth

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Date of birth is Required

Marital status

Spouse's name

Passport photo

* Passport photo
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Passport photo is required

Passport photo is Required

Home address

* Preferred address

* Address 1 Home address is Required

Address 2

* Suburb Suburb is Required

* State

* Postcode Postcode is Required

* Country Country is Required

Practice address

* Preferred address

* Address 1 Practice address is Required

Address 2

* Suburb Suburb is Required

* State

* Postcode Postcode is Required

* Country Country is Required

Contact details

* Email Email is Required

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

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CV is required

CV is Required

Proposers

* Proposer's name Please name an AOA member Proposer's name is Required

* Seconder's name: Please name an AOA member Seconder's name is Required

I agree with AOA membership application terms and conditions.