American Urological Association
2014 Gold Cystoscope Award Nomination Form
For nominations submitted by Urology Chairs and Program Directors
The Gold Cystoscope Award may be presented annually to a urologist who has distinguished him/herself by outstanding contributions to the profession within ten (10) years of completing residency training (residency must be completed no earlier than June 2004). Sponsor: Olympus.
Please complete each section of this form in its entirety and attach an abbreviated CV (no more than 3 pages in length). Only nominations received from Urology Program Chairs & Directors will be accepted. Questions regarding the nomination process may be directed to Nancy Waid, AUA Committee & Society Affairs at nwaid@AUAnet.org.
Deadline to receive nominations is October 31st