AAOE Member Application

Online Membership Application

Membership Benefits

Annual dues are $200.00 per year (Jan-Dec). There are no refunds or transference of membership. Dues notices are sent out in October. The AAOE membership dues are not deductible as a charitable contribution, but may be deductible as an ordinary and necessary business expense.

A requirement for maintaining membership is full payment of annual dues and assessments. Members whose assessment charges are not paid within (2) months of billing shall be removed from membership.

*Please note membership dues are not prorated or approved during the Annual Conference.

*Membership Committee will determine eligibility and membership categories. Membership Categories are located in the membership brochure.

General Information

	Name
	Title
	Date of Birth	(not published)
	Gender	Male Female

Medical Group/Practice Name (as it should appear in the directory)

Address

Please indicate address that should appear in the directory

Address Type

Home Office

	Address Line 1
	Address Line 2
	Address Line 3
	City	State Zip

Phone/Fax/Email

	Office Phone
	Office Fax
	Office Email

Membership Eligibility

Are you currently employed by a group (i.e. clinic, hospital, solo practicce or academic institution) that has at least one orthopaedic surgeon who is a member in the American Academy of Orthopaedic surgeons and/or the American Osteopathic Academy of Orthopaedic?

Yes No

Name of AAOS/AOAO member

Are you employed in the management of a group, clinic, hospital or academic institution which gives you the authority to hire and discharge personnel?

Yes No

If not, why

3.	Do you currently hold a management position within the group that involves the day-to-day management of the practice?	Yes No
4a.	Do you report directly to orthopaedic surgeon or other physician?	Yes No

Please list name and title/position

4b.

Please provide name of person or entity to whom you report

and their title/position

4c.

Is there a current AAOE member in your group?

Yes No

Please list name and title/position

Practice Profile

1. Please indicate any professional certifications (e.g. CPA, FACMPE, CMPE)

2. In what year did you begin your career in orthopaedic management?

3. Are you a member of a state AAOE?

Yes No

Which one?

4. Which of the following best describes your practice type?

	Private Practice	Solo practice
	Orthopaedic Group	Multi-specialty Group
	University Affiliated	Hospital based/owned
	Pre-paid plan/HMO	Clinical hospital/other group

5. How many orthopaedic surgeons are there in your group?

6. What is the total number of FTEs (excluding physicians) on your staff?

7. Does your practice employ (select all that apply)

	Registered nurse	Hand therapist
	Nurse practitioner	Orthopaedic technologist
	Physical therapist	Occupational therapist
	Physician assistant	Radiological technologist
	Surgical assistant	Orthopaedic physician assistant

Other:

8. How many office locations does your group have?

9. Does your group directly provide (check all that apply)

	Ambulatory surgery	X-Ray
	Physical Therapy	Imaging
	Sonorex

Other:

10. In your practice, what percentage of your patients are: (must total 100%)

	% Private Pay	% HMO/Capitation
	% HMO/PPO/IPA	% Medicare
	% Workers Compensation	% Medicaid
	% Charity	% Blue Shield
	% Other

American Association of Orthopaedic Executives :: 6300 North River Road, #727 :: Rosemont, IL 60018
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