Home About Us Board of Directors Committees Past Presidents ByLaws Constitution Meetings Upcoming Meetings Past Meetings Meeting Photos Post-Convention News Membership Member Application Member Application Members Only Profile Member Dues Member Directory Sign In Contact Us Meeting Menu Meeting Information Registration Hotel Information Accreditation Needs & Objectives Travel & Transportation Program Schedule Online Registration Indiana Urologic Association 2020 Annual Meeting February 22, 2020 JW Marriott Indianapolis Indianapolis, Indiana The deadline for discounted early registration is Friday, January 31, 2020. After 1/31/2020, regular registration fees will apply to online and on-site registration. Online registration will close on Tuesday, February 11, 2020 at noon Central Time. After 2/11/2020, 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: Select One Fellow Full-Time Administrator Industry Employee Nonphysician Provider Other Other Medical Professional Physician Researcher Resident Student/Trainee Urologist Urology Fellow Urology Resident Fellowship/Residency Program: Expected Graduation Year: Select One 2019 2020 2021 2022 2023 2024 2025 How did you learn about this conference? Select One Advertisement in Professional Journal Calendar/Monthly Listing Email Member Newsletter Registration Brochure Mailer Website Word of Mouth/Colleague Please Check ALL Areas of Practice Emphasis: (Check all that apply) AndrologyOncologic Urology - KidneyBenign Prostatic DiseaseOncologic Urology - ProstateCalculus DiseaseOncologic Urology - PenileCryosurgeryOncologic Urology - RenalEndourologyOncologic Urology - TesticularFemale UrologyOncologic Urology - All formsFetal UrologyPediatric UrologyGeriatric UrologyReconstructive UrologyIncontinence - FemaleRenal TransplantationIncontinence - MaleRoboticsLaparoscopySexual Medicine - FemaleNeurourologySexual Medicine - MaleOncologic Urology - BladderDoes Not Apply Are you a member of the American College of Surgeons (ACS)?: YesNo To expedite CME processing, please enter your ACS member ID: Registrant Information Address Type: HomeOffice Emergency Contact Information Meeting Registration Registration Categories Early Discounted through 1/31/2020 Regular Fees after 1/31/2020 Physician Members $100 $125 Physician Nonmembers $175 $225 Practice Managers - Members $50 $75 Practice Managers - Nonmembers $100 $125 Nonphysician Providers Complimentary Complimentary Residents Complimentary Complimentary Fellows Complimentary Complimentary Students Complimentary Complimentary Industry Employee - Supporting/MSL Industry Employee whose company is already supporting IUA OR Industry Medical Science Liaison (Proof of MSL Title may be required before confirmation of registration) $225 Industry Employee - Non-Supporting Industry Employee whose company is NOT already supporting IUA $950 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 email@example.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) CheckCredit Card --Select Card-- Visa MasterCard American Express 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 I have read, understood and agree to the electronic delivery of the data collected and payment amount. SIGNATURE: By selecting “I Agree” I represent and acknowledge that: I have read, understood, and consented to electronic delivery of the data collected and payment entered above. I have granted authorization to IUA in association with WJ Weiser & Associates, Inc. to charge the amount indicated on the credit card provided. I am the authorized user of the credit card listed above and that the associated information entered (account holder name, account number, billing address, etc.) is accurate. I intend the act of selecting “I Agree” to be my legal signature to this agreement. This question is for testing whether you are a human visitor and to prevent automated spam submissions. Enter in the Following Security Code: 684338 Registration Cancellation and Refund Policy Registration refund requests must be submitted in writing to the WUF Executive Office no later than January 31, 2020. All refund requests will be subject to a $100.00 processing fee. No refunds will be made after January 31, 2020.