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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: [phone], 9811967820
Email : [e-mail]
Website : http://www.ioaindia.org

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Dear Sir,

I wish to apply for the LIFE/

ASSOCIATE

Membership of Indian Orthopaedic Association

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Name (BLOCK LETTERS)

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

PG Degree / Diploma

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

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Institution

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

Place & Date

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Proposed By
(NAME IN BLOCK LETTERS)
SIGNATURE

SIGNATURE

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Seconded By
(NAME IN BLOCK LETTERS)

Signature

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

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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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