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IOA Membership Form
The Hon. Secretary, Indian Orthopaedic Association,
IOA House, 69 Tughlakabad Inst. Area,
Behind Batra Hospital, M.B.Road,
New Delhi – 62, Ph: +91-11-29961434, 9811967820
Email : ioahousedelhi@gmail.com
Website : http://www.ioaindia.org

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Dear Sir,

I wish to apply for the LIFE/

ASSOCIATE

Membership of Indian Orthopaedic Association

……………………………………………………………………………………………………………………

Name (BLOCK LETTERS)

Postal Address ………….………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
State ……………………………………………………Pincode………………………..Date of Birth……………….……………………………….
Email………………………………………………………………………… ……………………………………………………………………………
Telephone………………………………………………………………Mobile No. ……………………………………………………………………

PG Degree / Diploma

…………………………………………………………………………………… Year ………………………………….

………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
Institution

…………………………………………………………………………………………………………………………………………

I enclose the payment of Rs. …………………………. By Cheque / DD No ……………………………………………………………………….

Place & Date

…………………………………………

Proposed By
(NAME IN BLOCK LETTERS)
SIGNATURE

SIGNATURE

…………………………………………………………………………………………………………………

…………………………………………………….

Seconded By
(NAME IN BLOCK LETTERS)

Signature

IOA MEMBERSHIP NO…………………….………………………………..

…………………………………………………………………………………………………………………...

…………………………………………………….

IOA MEMBERSHIP NO…………………….………………………………..

The membership fee for Life Membership is Rs. 5,000/- and Associate member have to pay Rs.2,000/- in the first term during the Ortho. Taining ( PG) and Rs.3,000/- after M.S. (Orth.) etc, qualification to become Life member of IOA.( a decision has taken of IOA E.C meet and AGM in 2008 at
Bangalore.) Please make Daft in favour of “Indian Orthopaedic Association” payable at New Delhi
PLEASE NOTE:
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