PLEASE NOTE

Microsoft has ended support for its pre-IE11 browsers as of January 2016 and will be discontinuing IE11 support in August 2021.

If you are seeing this message, you are viewing the site on one of these unsupported browsers. We only support the recent versions of major browsers such as Chrome, Firefox, Safari, and Edge.

Thank you.

(click to close and continue using this browser)
Indiana Urologic Association, Inc. (IUA)

Indiana Urologic Association, Inc.

Membership Application

Membership Category
Active Membership in this Society is limited to licensed physicians of who reside and practice Urology in the state of Indiana and have an unrestricted license to practice medicine.
Affiliate Membership in this Society includes licensed physicians in related fields of medicine and science who cannot qualify for active membership and Non-physicians who, by their professional or personal accomplishments have contributed significantly to medicine in general or the specialty of urology.
Candidate Membership in the Society is limited to residents in an accredited Urology training program within the state of Indiana. Such membership will terminate with completion or discontinuation of such residency training. There are no annual dues.

Applicant Information

Please Check ALL (Check all that apply)

Applicant Addresses

Office Address


Home Address

Payment Information (must be made in U.S. dollars)

  • Billing Information

If paying by check, make check payable to: Indiana Urologic Association

Mail payment to:
Indiana Urologic Association
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

  • 292385