AONA Application for
Visiting Professor Program



(Invite an AO/ASIF Expert)

(typewritten only)

Information pertaining to sponsoring Institution:

Name of Your Institution_____________________________________________
Department Chairman_____________________________________________
Professorship Organizer_____________________________________________
Dates of Professorship_____________________________________________
Address of Institution_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Telephone Number _____________________________________________
Fax Number _____________________________________________
Visiting Professor _____________________________________________
Address _____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Telephone Number _____________________________________________
Fax Number _____________________________________________


Objectives/Goals

Please outline the intended objectives/goals of the Professorship.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Please indicate what educational format will be utilized. (for example, lecture, grand rounds, etc.)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

AO North America must receive this application at least three weeks prior to the date of the Visiting Professor's visit. Applications received after this deadline will not be accepted.

Please send completed application to:

AO North America
P. O. Box 308
Devon, PA 19333-0308
Fax: (610) 251-9059

*** Please be sure to include letter of invitation to the visiting professor and his/her letter of acceptance.

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

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