North Central Section of the AUA, Inc. North Central Section of the AUA, Inc.

Membership Application

Please Note: This application is for Affiliate, Advanced Practice Provider, Allied or Research Scientist Memberships only. If you wish to apply for Active or Associate Membership, please visit the AUA website.

Membership Category




Affiliate membership is available to Non-urologist MDs or Doctors of Osteopathy who are significantly contributing to the field of urology through clinical practice.
Research Scientist Membership is available for independent investigators with PhDs or equivalent degrees, DVMs, non-practicing MDs and related professionals who have demonstrated achievements in the field of urology through research or who have made substantial contributions to urologic research in an administrative capacity.
Allied Membership is available to non-physician professionals, including nurses (e.g., RN, LPN, LVN), medical technicians, and medical assistants, specializing or concentrating in urology for at least one year.
Advanced Practice Provider Membership is available to physician assistants, nurse practitioners or advanced practice nurses specializing or concentrating in urology for at least one year.

Applicant Information


Applicant Addresses

Office Address

Home Address


In addition to the submission of this form, you must also submit your CV:
Please submit only 10 pages or less (an abridged version is acceptable).


  • Via Email: amy@wjweiser.com
  • Via Mail:
    North Central Section of the AUA, Inc.
    1100 E. Woodfield Road, Suite 350
    Schaumburg, IL 60173
    F: (847) 517-7229

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

  • Billing Information

If paying by check, make check payable to: North Central Section of the AUA, Inc.

Mail payment to:
North Central Section of the AUA, Inc.
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

  • 300072