Membership form
NATIONAL ASSOCIATION for PROSTHETICS & ORTHOTICS
Application for membership
NAPO No.________________________
Name ___________________________________________________
Father name______________________________________________
Date of Birth______________________________________________
Age_______________________ Sex___________________________
N.I.C No._________________________________________________
Address__________________________________________________
________________________________________________________
City___________________Province___________________________
Country__________________________________________________
Phone___________________________________________________
Mobile___________________________________________________
Email____________________________________________________
Website__________________________________________________
Professional Qualification_________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Present Position__________________________________________________
_______________________________________________________________
Experience_______________________________________________________
________________________________________________________________
Membership of Other socities________________________________________
________________________________________________________________
Session of BSc.Orthotics and Prosthetics ______________________________
I ----------------------------------- hereby declare that I will follow the terms & rules of the membership as issued by the NAPO.(It is clarify that this Association has no political agenda).the main object of this association is to develop a working platform among orthotist/Prosthetist
Applicant Signature-------------------------- Date------------------------------