Affiliate membership - AOA | Australian Orthopaedic Association

1 About you
2 Contact & addresses
3 Credentials
4 Review & submit

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Personal details

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* Title

* First name
(Please use full given name)

Other name(s)

* Last name

* Date of birth

Spouse's name

Passport photo

* Passport photo

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Contact addresses

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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

Home phone

Work phone

* Mobile phone

Fax

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Professional qualifications

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* 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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About you

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Contact & addresses

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Credentials

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