AO Fellowships

Host center application form

Welcome to the online AO Trauma Fellowship Host Center application form.

Please enter your details in the form by completing each of the upcoming four steps. Fields with a red asterisk (*) are mandatory and therefore must be completed. Some fields have an associated hint which can be made visible by moving your cursor over the icon. To move backward and forward through the form, use the step bar.

Within 24 hours of submitting the form, you will receive an e-mail confirming the submission of your application.

If you have any questions, please contact us at trauma@fellows.aofoundation.org

Host center contact information

Name of hospital *

Street address *

Postcode/zip code *

City *

Country *

State/region *

Telephone *

Website address *

Host center

Practice settings *

Private hospital

Teaching hospital/university hospital

Department

Department name *

Head of trauma department/center

Family name *

First name *

E-mail address *

Telephone *

Secretary

Family name *

First name *

E-mail address *

Telephone *

Second secretary

Family name

First name

E-mail address

Telephone

AO Trauma faculty members

A minimum of two AO Trauma faculty members with an active membership is required for application to become an AO Trauma Fellowship Host Center.

Number of AO Trauma faculty members *