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Application Form for IOA Inland Fellowship 2023
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Name
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Mobile no
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IOA  LM NO
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Working Institute (Name and Place)
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Working Institute
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Fellowships Applied For 1
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Fellowships Applied For 2
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Fellowships Applied For 3
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Personal Information: Name
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Personal Information: Date of Birth
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Personal Information: Address
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Personal Information: Mobile No.
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Personal Information: Email
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Personal Information: IOA Membership No.
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Post Graduate qualifications in Orthopaedics (with year of passing) M.S.
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Post Graduate qualifications in Orthopaedics (with year of passing) D.N.B.
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Post Graduate qualifications in Orthopaedics (with year of passing) Other Qualifications:  M. Ch. (Orth) /FRCS / Ph. D. (Ortho)
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Experience 1. Present Appointment: Nature of work & date of appointment
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Experience 1. Present Appointment: No. of Orthopaedic Beds
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Experience 1. Present Appointment: Teaching/ Non Teaching
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Experience 1. Present Appointment: Specialized Work
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Experience 1. Present Appointment: Research Work
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Experience 2. Past Appointment: Nature of work & date of appointment
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Experience 2. Past Appointment: No. of Orthopaedic Beds
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Experience 2. Past Appointment: Teaching/Non Teaching
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Experience 2. Past Appointment: Specialized Work
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Experience 2. Past Appointment: Research Work
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Experience 3. Teaching experience as Lecturer/ Assistant Professor or above (with duration)
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Publications In Indexed Journals/ IJO as main author
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Publications In Indexed Journals/ IJO as co author
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Publications in Non Indexed Journals as main author
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Publications in Non Indexed Journals as co author
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Publications Books: Main Author
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Publications Books: Associate Author
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PAPERS / POSTERS PRESENTED PERSONALLY in International Conferences abroad
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PAPERS / POSTERS PRESENTED PERSONALLY: in International Conferences/IOACON in India
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PAPERS / POSTERS PRESENTED PERSONALLY in Sub-specialty & State Conferences
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GUEST LECTURES / LECTURES AT CME / WORKSHOPS: International Conferences abroad
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GUEST LECTURES / LECTURES AT CME / WORKSHOPS: International Conferences in India/ IOACON
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GUEST LECTURES / LECTURES AT CME / WORKSHOPS: Sub-specialty/ State Conferences
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RESEARCH PROJECTS COMPLETED: (provide photocopy of certificate of completion): Name of Project
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RESEARCH PROJECTS COMPLETED: Funding Agency
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RESEARCH PROJECTS COMPLETED: Principal & other investigators
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RESEARCH PROJECTS COMPLETED: Date of starting project
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RESEARCH PROJECTS COMPLETED: Date of completion/ submitting report
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RESEARCH PROJECTS COMPLETED:Duration of involvement in project
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CONFERENCES ATTENDED: International Conferences abroad
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CONFERENCES ATTENDED: International Conferences in India/ IOACON
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CONFERENCES ATTENDED: Sub=Specialty/ State Conferences
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ORGANIZATIONAL (Convener or Organizing Secretary of International or National/State meeting or workshops / Office bearer of National organization)
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MEDALS. PRIZES, AND AWARDS IN ORTHOPAEDICS
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Statement of Purpose (SOP) in 250 words
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UPLOAD CV (If there is any issue with uploading send CV to  inlandfellowship.ioa@gmail.com after filling the google form
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Date
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Place:
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