Membership Category

Institution Information

• Include this institution in the member directory of the website.
• Institution Name
• Institution Address Line 1
• Institution Address Line 2
• Institution Address Line 3
• Institution City
• Institution State
• Institution ZIP
• Institution Phone
• Website URL

Institution Staff

• Program Director Full Name
• Program Director Email
• The Program Director will be responsible for confirming the institution’s individual list yearly.
• Urology Chair Full Name
• Urology Chair Email
• Program Coordinator Full Name
• Program Coordinator Email
• Billing Contact Full Name
• Billing Contact Email

Additional Staff

All faculty members at a member institution are eligible to take advantage of SAU member benefits. Please provide a list of the institution’s urology faculty. If you would prefer or there are more than five additional faculty members, you may upload a list, but please include each individual member’s full name and unique contact email address.

• Membership List Upload:
  (Allowed filetypes: XLS, XLSX, DOC, DOCX, RTF, PDF)
• Member Full Name 1
• Member Email 1
• Member Full Name 2
• Member Email 2
• Member Full Name 3
• Member Email 3
• Member Full Name 4
• Member Email 4
• Member Full Name 5
• Member Email 5

• TOTAL AMOUNT DUE: