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Election Notice
Nomination Form
GOACON 2012 by VAPI-VALSAD ORTHOPEDIC FORUM at Daman on 3rd,4th and 5th February 2012

GOA Post Graduate Quiz & CME on ‘Skeletal Growth and Growth Modulation – The Past, Present and Future’ on 18th September, Sunday at Seva Sansthan (Polio Foundation), Ahmedabad

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PERSONAl DETAILS
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Applying for
Life Membership Full Membership Associate Membership
 
First name: Middle name:
Last name: Date of Birth:
Qualifications: Year of Post-graduation:
 
Institute of Post-graduation:
 

CONTACT DETAILS
(Please Mark the address which you went as your postal address)
Work address:
Work Address (Cont'd):
City/Town: Pin Code:
Work phone(with STD):
Home Address:
Home Address (Cont'd):
City/Town: Pin Code:
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URl:
OFFICIAl AND ACADEMIC INFORMATION Experience in orthopaedics and publications
Member of IOA? Yes No IOA membership Number
Medical Registration Number and place:
PAYMENT DETAILS Cheque or Draft no: Drawee BankName:
Amount: Dated:
REFERENCES Proposed by:
Seconded by:
 
 
I have read the constitution of the Gujarat Orthopedic Association. By submitting this application. I pledge to abide by it.
Constitution is available on our website www.goa.org.in

Signature of Applicant with Date

Application of Membership of

GUJARAT ORTHOPAEDIC  ASSOCIATION
The Gujarat Orthopedic Association is a chapter of “Indian Orthopedic Association”. The object of the association is the advancement of science, art  and practice of orthopedic surgery. The association has Yearly conference in the first week of February. It also conducts postgraduate lecture and fellowship programmes.

Life member and full members may be elected from those who hold the postgraduate Degree or Diploma in Orthopaedic and /or its equivalent, or from surgeons practicing orthopaedics exclusively.

Associate member may be elected from
  1. Those who are in training in orthopaedic surgery
  2. Those in allied surgical specialties or medical branches related to orthopaedic surgery.
All the applications must be proposed and seconded by two full/life members of the association. Annual subscription for full and associate members are due on 1st April of each year and are payable in advance.

SUBSCRIPTION FEES
Category Fees Admission
Life Member Rs.3500/- -
*(Please add Rs.10/- towards bank charges)

Demand Draft must be in favour of “GUJARATH ORTHOPAEDIC ASSOCIATION” payable at “Ahmedabad”

The application from with the above information should be sent with the payment (D/D)directly to:
Dr.Hasmukh Nagwadia

Honorary Secretary, Gujarat Orthopaedic Association
E/12 Sharanam - 11, Nr. Heavan Park
Opp. Karnavati Club, Prahaladnagar,
Ahmedabad - 380015

Phone: 91-079-26937890 Mobile: 9723814800
E-Mail: hpnag87@yahoo.com
You can also fill up the form online and send the copy of the same with the demand draft.
GOA website subscribes to the HON code principles of the Health On the Net Foundation
Website is managed by Dr. Hasmukh Nagwadia, Honorary Secretary - Gujarat Orthopaedic Association.

E/12 Sharanam - 11, Nr.Heavan Park, Opp. Karnavati Club, Prahaladnagar, Ahmedabad - 380015. Ph.: 079 - 26937890