LOUISIANA ORTHOPÆDIC ASSOCIATION

The Association informs its members of insurance (workman compensation, Medicare, and health insurance) regulations, business, political, and legislative issues through its newsletter, meetings and this website. Annual dues for membership is $300 per year and is collected between December and January.

Application for Membership

Membership Class (circle one): Active, Honorary, Senior, Associate, Provisional and Resident/fellow.

Your Name (Last, First, MI) _______________________________________________

Year of Medical Degree ________ Medical School _____________________________

Subspecialty (ies) _______________________________________________________

Board Certified Status: Board Certified
Board Eligible (date expected to become Board Certified___________)
Other____________________________________________

Method(s) you wish the LOA to contact you (please rank 1-4 1 is you first preference)

Rank	Method	Contact information (please complete each box below)
	Email
	Fax
	Postal
	Telephone
	Home address
	Office Address
	Other if any

Medical Practice Name:____________________________________________________

List any special items or interest you would like to participate in at the LOA: (e.g., political action committee, association officer, committee interest, annual meeting organization or other activity)

Return application and $300 dues to LOA, 1612 Oleander Street, Meatirie, LA, 70001. If you wish to get on mailing list immediately, Email to Ben McKown (laorthoassoc@aol.com) check to follow.

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