Fields with * are required.
Credentials & Certifications:
AUA ID Number (if known):
Employer Address 2:
Name of Undergraduate Institution:
Name of Graduate Institution:
Years in Practice:
Years in Urology:
Additional details about areas of expertise:
Provide a brief Bio (Maximum 250 words):
Upload any supporting files below. (Note:The filename should not should contain any punctuation, special or foreign characters.)
If you have any problems with submitting your documents, please contact education@AUAnet.org. (Si tiene problemas tecnicas, mande un correo electronico a firstname.lastname@example.org)
Allowed file types: PDF, PNG, JPG, JPEG, GIF
The maximum total file size for all documents should be less than 4MB. Total file size submissions exceeding 4MB may result in an error and delays with processing your application. (El tamaño máximo de archivo total para todos los documentos debe ser inferior a 4 MB. El total de envíos de archivos que superen los 4 MB puede ocasionar un error y demoras en el procesamiento de la aplicación.)
Letter(s) of Recommendation (One must be from a current AUA Member):
If you have any additional Letters of Recommendation or Speaker Evaluations that you would like to include, please email them to
Why do you want to be on the AUA Speakers Bureau? (Maximum 250 words):
Do you have any special requirements? (Note: The AUA and each AUA Section have their own travel and honoraria policies.)
Distance of travel?:
Amount of Lead Time?:
AUA's APP Speaker's Bureau Agreement
As a speaker for the American Urological Association (AUA), you are required to:
Maintain an active AUA membership status.
Notify the AUA of any changes to employment at
education@AUAnet.org. Respond promptly to inquiries from AUA or AUA Sections regarding speaking availability.
Adhere to the AUA Speaker Guidelines outlined below.
Continuing medical education (CME) consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. The content of CME is that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public.
The AUA Office of Education requires anyone who is the position to control the content of an accredited CME activity [e.g. scientific program directors, faculty presenters, speakers, moderators, program planners, contributors, editors and presenting authors]:
Must not be an employee or owner a commercial interest [aka ACCME ineligible company] at any time during the planning or presentation of a CME activity. A commercial interest is defined as a company whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients [Standard 3.2]
Disclose all financial relationships with any commercial interest within the past 24 months. [Standard 3.1] If you have not already done so, please update your disclosures:
www.auanet.org/coi. Base all the recommendations for patient care on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options. [Standard 1.1]
Ensure that all scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, analysis, and interpretation. [Standard 1.2]
Refrain from advocating for or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning and disclose to learners when discussing such within the accredited activity. [Standard 1.3]
Provide strong support from the overall body of evidence if claiming the superiority of one technology, program, product, device, drug or service over another. [AUA]
Refrain from recommendations, treatments, or manners of practicing medicine that are known to have risks or dangers that outweigh benefits or are known to be ineffective in the treatment of patients. [Standard 1.4]
Develop content that promotes improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. [Standard 5.2c]
Refrain from actively promoting or selling products and/or services that serve your own professional or financial interests during the accredited activity. [Standard 2.2]
Receive no payments for participation with the exception of those provided by AUA. [Standard 2.2]
Refrain from speaking at an industry sponsored non-CME activity held during the program. [AUA]
I have read and agree to abide by these guidelines in my contributions to AUA CME activities.