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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