Fellowship of AOA - AOA | Australian Orthopaedic Association

Personal details

* Title

* First name
(Please use full given name) First name is Required

Other name(s)

* Last name Last name is Required

Preferred name
(Leave blank if the same as First Name)

* Date of birth

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Date of birth is Required

Spouse's name

Passport Photo

* Passport Photo Passport Photo is Required

CPD Compliance

* Are you CPD compliant?

* Upload your CPD certificate
(Max file size 10mb)

Contact Details

* Email Email is Required

Home Phone

Work Phone

* Mobile phone Mobile phone is Required

Fax

Home address

Preferred Address

* Address 1 Home Address is Required

Address 2

* Suburb Suburb is Required

* State State is Required

* 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 State is Required

* Postcode Postcode is Required

* Country Country is Required

Professional qualifications

* Degrees and diplomas (with awarding institutions and names)

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

* Upload file
(Max file size 10mb) Curriculum vitae is Required

Proposers

* Proposer's name Proposer's name is Required

* Seconder's name Seconder's name is Required

I agree with AOA membership application terms and conditions.

Payment details

Application Fees $210.00

* Credit card type Credit card type is Required

* Name on credit card Name on credit card is Required

* Credit card number Credit card number is Required

* Credit card expiry Credit card expiry is Required Credit card expiry is Required

* CCV CCV is Required