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Application Form for Membership of AOH

Name of the Hospital

Name of Trust

Year of Establishment

Address in Full

Telephone Numbers

E-mail address

Fax Number

Names and Addresses of Trustees or Members of the Managing Committee

Name of Medical Director or Medical Superintendent

Name of the Representative and his/her designation

Name of the alternate representative and his/her designation

Number of beds in the Hospital category wise

Special Facilities

Any other Information

A photograph of the Hospital