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380 St Kilda Road, Melbourne, Australia

Call Us: (210) 123-451 (Sat - Thursday)

Monday - Friday (10am - 05 pm)

380 St Kilda Road, Melbourne, Australia

Call Us: (210) 123-451 (Sat - Thursday)

Monday - Friday (10am - 05 pm)

MOA - New Member

Life Membership Plan (MOA) - New Member
₹5,900.00
This membership plan is for NEW Members, who have not paid to Maharashtra Orthopaedic Association (MOA).
Plan Detail - Rs. 5000 + 18% GST

To,
The Hon. Secretary and Treasurer
Maharashtra Orthopaedic Association

Dr. N J Karne
Karne Hospital, Near Laxminarayan Theater,
Satara Road, Pune 411037
Contact: 9822036724, Email: officeofmoa@gmail.com,
Website: www.mahaortho.org

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

* Your Name
* First
* Surname
* Father's/Husband's Name*
*
* Postal Address:*
* Street Address
District

State

Pin Code

* Contact Number
*
DOB.

* Mobile No.:*
*
* Email Address
*
will be use as username
Qualification: Degree / Diploma 1

Institute / University:
Year

Qualification: Degree / Diploma 2:

Institute / University:
Year

MMC Registration No.

Year

Proposed by : Dr

*Kindly upload your signature along with attachments
MOA Life Membership No.

Seconded by : Dr

MOA Life Membership No.

*Kindly upload your signature along with attachments
IOA Member – Yes/No If Yes – IOA No.

IMPORTANT : Please attach one passport size photograph with the application form and copies of Qualification Certificates.

* Upload Passport Size Photograph
(Use Cropper to set image and
use mouse scroller for zoom image.)
(Use Cropper to set image and use mouse scroller for zoom image.)
Only JPG/PNG File

* Upload Application Form & Signatures
Only JPG/PNG/PDF File

Note: You can upload multiples files.
* Upload Your Degrees
Upload ONLY JPG/PNG/PDF

Note: You can upload multiples files.
* Upload Your Aadhar Card
Upload ONLY JPG/PNG/PDF

Note: upload 2 files for Front & Back side
Profile Section

* Password
Strength: Very Weak
* Confirm password
* Terms & Conditions*
I agree to abide by the rules & regulations of Maharashtra Orthopaedic Association.

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