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

Membership Application

Membership Type


Requirements for Active Membership are as follows: A) Possession of an unlimited license to practice medicine and surgery in the state, province, or country of the applicant’s residence; B) Practice in the geographical boundaries of the North Central Section; C) Possession of an MD or DO degree and completion of an accredited urology residency; D) Limitation of practice to the specialty of urology; E) Certification by the American Board of Urology (ABU), the Royal College of Surgeons (RCS) in Canada or the Quebec Board of Urology or the certifying board of urology in the country where practicing within the geographical boundaries of the Section; F) Recommendation for membership by two (2) voting members of the section, except if certified within the last 24 months (as per item E in this section); G) Letter of recommendation from the chief of urology, medical director or chair of the credentials committee at the hospital(s) where the applicant has privileges

  • Year of Certification:
  • Certifying Board:


Requirements for Associate Membership are the same as Active Membership, except for board certification. A) Candidate members eligible for Fast Track Associate status: Associate Membership will be offered to all candidate members who have passed the qualifying examination (Part I) of the American Board of Urology; B) Non-members eligible for Associate status: Associate Membership is available to non-member urologists who are practicing within the geographic boundaries of the Section but are not certified by the American Board of Urology



Affiliate membership is available to Non-Physician Scientists and is not usually available for physicians certified by medical boards. However, in exceptional instances, persons in related fields of medicine and science, who do not qualify for other categories of Section membership, may be considered for Affiliate Membership provided they have contributed significantly to the specialty of Urology. They shall be nominated by two (2) Active or Senior Members who shall furnish the Section Board of Directors with the curricula vitae and other pertinent information.

Applicant Information

  • Legal Citizen where you Practice?: 
  • Please select a category that best describes your status:

Addresses

Preferred Mailing Address: 

Office

Home

All applicants must provide names and addresses of two Active or Senior members of the Section who will endorse this application in accordance with Section requirements.

  • Sponsor Name:
  • Sponsor Name:

Education, Training, and Professional Experience

  • Is your Urology Residency Program approved by the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada?

Advanced Post-Urological Training

  • Name of Institution:
  • City:
  • Dates:

Where have you practiced since completing your urological residency?

  • Location:
  • Dates:

Hospital Appointments Currently Held

  • Hospital Name:
  • Location:
  • Size:
  • Type:

Teaching Positions Held (Past or Present)

  • Title:
  • Position:
  • TOTAL AMOUNT DUE:

All applications will be kept on file at the North Central Section and a copy will be forwarded to the AUA when applying for AUA membership.

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

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

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