Please list at least three (3) urologic, peer-reviewed scientific journals in which you have been published in the last five (5) years.
Please list at least three (3) regional or international urological meetings in which you have served as a speaker, moderator, or educational course faculty in the last five (5) years.
By submitting this application, I do hereby certify that all information recorded on this application and any attached documents is accurate and supports my qualifications to become an Accredited Faculty member in the AUA International Academy for which I now apply. I hereby agree that the American Urological Association may verify any data provided with this application. If elected, I agree to conform to all applicable policies and requirements of the AUA and to uphold the Code of Ethics.
Thank you for completing the AUA International Academy Accredited Faculty Application Form. We appreciate your interest in the AUA.