ASSN

Become A Member

Please fill in the details required in the form and complete all the steps to become our member.

Membership Form

Membership Criteria
Personal Information
Residential Address
Professional Address
Professional Qualification/s
Confirm

After PG in Ortho or Neurosurgery duly registered in NMC

Has participated in at least one ASSN conference Plus Has participated in at least one course organized by ASSN or endorsed by ASSN

Has done fellowship of at least 3 months duration recognized by ASSN

Has done fellowship recommended by ASSN

Has participated in at least one ASSN conference or Has participated in at least One course organized by ASSN or endorsed by ASSN or Has presented paper in ASSN conference Plus Has done International course recognized by ASSN like AO Spine Principle course

Full Name:

Mobile

Email:

Date of Birth:

Citizenship:

Male Female Rather not say

Permanent Address:

Tel No.

Present (if other than permanent address):

Tel No:

P.O. Box No:

Hospital/ Office

Designation

Hospital/Office Tel No::

Hospital/Office P.O. Box No:

Clinic:

Clinic Tel No:

Clinic P.O. Box No:

Nepal Medical Council Regn No.:

Other Regn. No./s:

Speciality

University-1

University-2

University-3

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