New Member Application and Upgrade Form

New Member Application and
Upgrade Form
AOTrauma membership fee
1 year Membership package: 2 years Membership package: 3 years Membership package: CHF 100
CHF 180
CHF 270
USD 100
USD 180
USD 270
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EUR 144
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I herewith confirm that I meet the AOTrauma membership prerequisites:
1: Are you a Musculosceletal professional?
yes no
2: Have you successfully completed an AO principles course?
yes no Please provide the course name, date and location.
(For researchers: please provide the musculoskeletal/trauma related research activity you are involved in.)
What is your main reason for becoming an AOTrauma member?
Access to educational and training resources
Reputation of AOTrauma as a leader in musculoskeletal trauma care
Being part of a global network/networking
Career development opportunities
Access to member benefits
Being an AOTrauma Faculty
Interested in Fellowship application
Previously associated with AOTrauma as AO Alumni
How did you learn about AOTrauma?
Recommendation by a colleague
AOTrauma presence at a global congress
Participation in an AOTrauma course
Recommendation by an industrial partner
Through the local country council
Printed advertisement
Internet search Other
Applicant information
First Name Last Name Date of birth: dd/mm/yyyy E-mail address Hospital name Department Street Address / P.O. Box Postal Code / Zip City Payment options
Credit Card
Country American Express
Bank Transfer
Please send your payment to the following bank account:
CREDIT SUISSE, 7270 Davos Platz, Switzerland
Account No: 614225-31 Clearing No*: 4835
IBAN: CH18 0483 5061 4225 3100 0 SWIFT: CRESCHZZ
Account Holder: AO Stiftung, Grabenstr. 15, CH-7000 Chur
Name as it appears on credit card Credit card number Security number (Visa/MC—3 numbers on back; AMEX—4 numbers on front)
Expiration Date (mm/yy) §
Cash (only in case of direct cash payment at an AOTrauma booth)
* Clearing No. = BLZ = Sort Code = ABA No. = Routing No.
lease enter a payment description as follows:
“AOTrauma membership fee—Month/Year”
• If you are making a payment on someone’s behalf, please include the
member’s full name in the payment description.
Member-exclusive benefits—reasons to join the AOTrauma network
Get connected through the Member directory
Access free e-books and other book discounts
Advance knowledge through Injury journal
and Journal of Perioperative practice
Explore Primal Pictures, 3D human anatomy
Please email your completed form to
[email protected],
fax it to +41 81 4142 283, or post it to:
Benefit from Fellowship opportunities
Access educational videos and lectures
Share knowledge through CaseForum
Choose from a variety of Ovid online journals
And access other special offers and discounts
AOTrauma Clavadelerstrasse 8, 7270 Davos, Switzerland
For more information:
Phone +41 81 414 21 11 |