Affiliate membership - AOA | Australian Orthopaedic Association

Personal details

* Title

* First name

Other name(s)

* Last name

* Date of birth

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Marital status

Spouse's name

Passport photo

* Passport photo
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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

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Proposers

* Proposer's name

* Seconder's name:

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