Maharashtra Orthopaedic Association 

Application for Life Membership

To,

The Hon. Secretary cum Treasurer

Maharashtra Orthopaedic Association
Dr. Nitin Deshpande,
Deshpande Orthopaedic Hospital, New Mahadwar Road, Kolhapur – 416 012.

Tel. 0231-2623664
Email : dohkpr@yahoo.com  Website : www.mahaortho.com

Dear Sir,

I, the undersigned wish to join Maharashtra Orthopaedic Association as Life Member. My details are given below.

My Personal Details are as follows

Qualification: Degree/Diploma
1.

2.


Application for Life Membership



I agree to abide by the rules & regulations of Maharashtra Orthopaedic Association.
Proposed by life member.



IOA member YesNo
If yes IOA No.

Signature of Applicant:


Important: Your membership is subject to ratification in the subsequent AGM of the Association during MOACON. Allotment of membership number will follow the ratification.

Note:By filing this membership form you will receive payment getaway link for payment of membership fee. Your membership will confirm after received fees.

Academic Section