Affiliate membership - AOA | Australian Orthopaedic Association

Personal details

* Title

* First name

Other name(s)

* Last name

* Date of birth

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

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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