Indiana Urologic Association, Inc. (IUA)

Indiana Urologic Association, Inc. (IUA)

Online Registration

Indiana Urologic Association

2018 Annual Meeting
February 24, 2018
JW Marriott Indianapolis
Indianapolis, Indiana


The deadline for discounted early registration is 1/31/2018.
After 1/31/2018, regular registration fees will apply to online and on-site registration.


Online Registration will close on Tuesday, February 13, 2018.
Registration will be available on-site at the meeting.

Registration Fees are subject to change. To lock in these rates, register now!
  • Please select the category that best describes your status:*

Please Check ALL Areas of Practice Emphasis:* (Check all that apply)










  • Are you a member of the American College of Surgeons?:*
  • If "Yes," please enter your member ID to expedite your CME processing:

How did you learn about this conference? (Check all that apply)



Registrant Information

  • First Name:*
  • Last Name:*
  • Degree(s):
  • Badge First Name:*
  • Address 1:*
  • Address 2:
  • City:*
  • State:*
  • ZIP Code:*
  • Country:*
  • Phone:*
  • FAX:
  • Email:*
  • Address Type:*

Meeting Registration

  • Registration Categories*
  • Early Discounted
    through 1/31/2018
  • Regular Fees
    after 1/31/2018
  • $100
  • $125
  • $175
  • $225
  • $50
  • $75
  • $100
  • $125
  • Complimentary
  • Complimentary
  • Complimentary
  • Complimentary
  • Complimentary
  • Complimentary
  • Complimentary
  • Complimentary

  • Industry Employee whose company is already supporting IUA OR Industry Medical Science Liaison (Proof of MSL Title may be required before confirmation of registration)
  • $175

  • Industry Employee whose company is NOT already supporting IUA
  • $875
  • Your submission will need to be approved prior to confirmation of your registration. Approval may be based on current Industry support. To find out if your company is currently supporting IUA, please contact Brittany Kallman in the Registration Department at (847) 264-5963 or by email at brittany@wjweiser.com.
  • TOTAL REGISTRATION FEE:

The IUA requires full payment for registration fees by check or credit card.

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

  • Billing Address:*
  • ZIP:*
  • Card Type:*
  • Name on Card:*
  • Card Number:*
  • Expiration Date: (mmyy)*
  • Card Verification #:*

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

  • This question is for testing whether you are a human visitor and to prevent automated spam submissions.
  • Enter in the Following Security Code: 648428

Registration Cancellation and Refund Policy

Registration refund requests must be submitted in writing to the IUA Executive Office no later than 1/31/2018. All refund requests will be subject to a $25 processing fee. No refunds will be made after 1/31/2018.