Registration Society of Academic Urologists 2020 Program Directors, Coordinators & Academicians Meeting January 24 – 25, 2020 Aria Resort & Casino Las Vegas, Nevada INDUSTRY EMPLOYEES ONLY For more information about attending the SAU 2019 Program Directors, Coordinators & Academicians Meeting, please contact JP Baunach in the Industry Relations Department at (847) 264-5942 or by email at firstname.lastname@example.org. The deadline for online registration is Monday, January 13, 2020. After this date, on-site registration will be available. Registration fees are subject to change. To lock in these rates, register now! Please select your role: Select One Program Coordinator Program Director Program Chair Academic Faculty Student Fellow 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 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 Registrant Institution SAU Member InstitutionNonmember Institution Select Member Institution Akron General Medical Center (Cleveland Clinic Akron General) Albany Medical College Augusta University Baylor College of Medicine Boston University Medical Center Brigham and Women's Hospital/Harvard Medical School Brown University/Rhode Island Hospital Carolinas Medical Center Case Western Reserve University Charleston Area Medical Center Cleveland Clinic Foundation Creighton University School of Medicine Dartmouth-Hitchcock Medical Center Detroit Medical Center Duke University Medical Center Eastern Virginia Medical School Emory University Geisinger Medical Center George Washington University Georgetown University Hospital/Washington Hospital Center Henry Ford Hospital Houston Methodist Urology Residency Program Indiana University Medical Center John H. Stroger Hospital of Cook County Johns Hopkins University Urology Department Kaiser Permanente Southern California (Los Angeles) Lahey Clinic Medical Center Lenox Hill Hospital Loma Linda University Medical Center Louisiana State University (New Orleans) Loyola University Madigan Army Medical Center Maimonides Medical Center Maine Medical Center Massachusetts General Hospital/Harvard Medical School Mayo Clinic Arizona Mayo Clinic School of Graduate Medical Education (Jacksonville) Mayo Clinic School of Graduate Medical Education (Rochester) Medical College of Wisconsin Medical University of South Carolina Michigan State University Montefiore Medical Center Mount Sinai Medical Center of Florida Mt. Sinai Medical Center Naval Medical Center (San Diego) New York Presbyterian Hospital (Columbia Campus) New York Presbyterian Hospital (Cornell Campus) New York University Medical Center Northwell Health Northwestern University Feinberg School of Medicine NYU Winthrop Hospital Ochsner Clinic Foundation Ohio State University Oregon Health & Science University Penn State University/Milton S. Hershey Medical Center Rush University Medical Center Rutgers - New Jersey Medical School Rutgers Robert Wood Johnson Medical School San Antonio Uniformed Services Health Education Consortium Southern Illinois University Urology St. Louis University Stanford University School of Medicine SUNY at Stony Brook SUNY Upstate Medical University Temple University School of Medicine Texas A&M HSC COM/S+W Medical Center Texas Tech University Health Science Center Thomas Jefferson University Tripler Army Medical Center Tulane University School of Medicine UC Irvine Medical Center UCLA Urology University At Buffalo University of Alabama at Birmingham University of Arizona College of Medicine University of Arkansas College of Medicine University of California (San Diego) University of California (San Francisco) University of California, Davis University of Chicago Medical Center University of Cincinnati Medical Center University of Colorado - Denver University of Connecticut University of Florida College of Medicine University of Illinois University of Iowa Hospitals and Clinics University of Kansas Medical Center University of Kentucky University of Massachusetts Medical Center University of Miami School of Medicine University of Michigan Medical Center Department of Urology University of Minnesota University of Mississippi Medical Center University of Missouri - Columbia University of Nebraska Medical Center University of New Mexico School of Medicine University of North Carolina School of Medicine University of Oklahoma University of Pennsylvania University of Pittsburgh Medical Center University of Puerto Rico University of Rochester Medical Center University of South Florida Morsani College of Medicine University of Southern California University of Tennessee (Memphis) University of Tennessee College of Medicine, Chattanooga University of Tennessee, Knoxville University of Texas Health Science Center (San Antonio) University of Texas Southwestern Medical School University of Toledo University of Toronto University of Utah School of Medicine University of Virginia University of Washington Medical Center University of Wisconsin (Madison) Vanderbilt University School of Medicine Virginia Commonwealth University Health System Virginia Mason Medical Center Wake Forest University School of Medicine Walter Reed Army Medical Center Washington University Wayne State University West Virginia University Westchester Medical Center William Beaumont Hospital Yale University School of Medicine Registrant Information Each registrant must fill out the information below. Address Type: HomeOffice Meeting Registration Registration Categories Regular Fees Member Program Coordinator $175 Member Program Director $525 Member Program Chair $750 Member Academic Urologist $425 Nonmember Program Coordinator $350 Nonmember Program Director & Academic Urologist $650 Nonmember Program Chair $850 Academic Nonphysician Provider $650 Other $650 Resident/Fellow/Student $75 Additional Tickets (One ticket included in registration fee) (Additional Evening Function Tickets for Non-Registered Guests) Welcome Reception # of tickets = 0 1 2 3 @ $50 per ticket Total Registration Fee: SAU requires full payment for registration fees and optional activities 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: Society of Academic Urologists Mail payment to: Society of Academic Urologists 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 SAU 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. Enter in the Following Security Code: 489131 Registration Cancellation and Refund Policy Registration refund requests must be submitted in writing to the SAU Executive Office no later than December 26, 2019. All refund requests will be subject to a $100 processing fee. No refunds will be made after December 26, 2019.