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Home Members & Membership Membership Application

Membership Application

Membership Category

Qualifications: Board certified or board eligible by the American Board of Urology (ABU) or its International equivalency. $100 payment of Annual Dues is required.
Qualifications: Practicing urologist who is not board (ABU) eligible or board certified. $100 payment of Annual Dues is required.
Qualifications: Advanced Practice Provider or a non-urologist MD/DO with an interest in urology. $50 payment of Annual Dues is required.
Qualifications: Physicians-in-training in any of the State’s accredited Urology Residency Training Programs. Annual Dues are waived.

Applicant Information

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: Louisiana Urological Society

Mail payment to:
Louisiana Urological Society
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

  • 326473
By submitting this application, I hereby certify that the information on this application is correct. If accepted for membership, I hereby agree to abide by the Constitution and Bylaws of the Louisiana State Urological Society.