Download - EAU Membership Application Form
PO Box 30016 6803 AA Arnhem The Netherlands
P +31 (0) 26 38 90 680 F +31 (0) 26 38 90 674
[email protected] www.uroweb.org
Membership Application Form
I wish to apply for:22 Active membership € 120 /year 22 A copy of my registration as certifi ed urologist is enclosed
22 Active Corresponding membership € 120 /year 22 A copy of my registration as certified urologist, or an endorsement
of my National Urological Society is enclosed
22 Corresponding membership € 150 /year 22 A copy of my registration as certifi ed urologist is enclosed
22 Junior membership € 75 /year 22 A copy of a letter by the Chief of my department ratifying my status as
urologist-in-training listing also my anticipated date of certifi cation as urologist is enclosed
22 Junior membership in combination with European Society of Residents in Urology (ESRU) membership € 50 /year
22 A copy of a letter by the Chief of my department ratifying my status as urologist-in-training listing also my anticipated date of certifi cation as urologist is enclosed
22 Junior Corresponding membership € 75 /year 22 A copy of a letter by the Chief of my department ratifying my status as urologist-in-training
listing also my anticipated date of certifi cation as urologist is enclosed
22 Affi liated membership € 100 /year 22 A copy of my Curriculum Vitae is enclosed
Please note: Applications that are not accompanied by the proper documents will be returned to sender.
Membership categories Active membership • Open to all European certifi ed urologists. • Eligible to vote at the General Assembly.
Active Corresponding membership • Open to all non-European certifi ed urologists residing in the following coun-tries: Morocco, Algeria, Tunisia, Libya, Egypt, Lebanon, Syria, Jordan and India.
• Not eligible to vote at the General Assembly.
Corresponding membership • Open to all non-European certifi ed urologists. • Not eligible to vote at the General Assembly.
Junior membership • Open to European urologists-in-training/residents. • Not eligible to vote at the General Assembly. • Upon certifi cation as urologist, one can apply for active membership.
Junior membership in • Open to European urologists-in-training/residents combination with ESRU • Not eligible to vote at the General Assembly. membership • Upon certifi cation as urologist, one can apply for active membership.
Junior Corresponding membership • Open to non-European urologists-in-training/residents. • Not eligible to vote at the General Assembly. • Upon certifi cation as urologist, one can apply for active corresponding/
corresponding membership.
Affi liated membership • Open to all scientists, or others who have contributed signifi cantly to the speciality of urology.
• Not eligible to vote at the General Assembly.
Personal dataPlease fi ll in the following items:
Title: 2 2 Prof. 2 2 Dr. 2 2 Mr. 2 2 Mrs. 2 2 Miss
Family Name:
First Name:
Date of Birth, Nationality:
Institution:
Department:
Address:
Postal code / Zip:
City:
Country:
Phone (offi ce):
Fax (offi ce):
E-mail (offi ce):
Home Address:
Postal code / Zip:
City:
Country:
Phone (home):
Fax (home):
E-mail (offi ce):
To which address do you wish your EAU correspondence to be mailed? 2 2 Work 22 Home
I wish to receive special information on:22 Andrological Urology (ESAU - European Society of Andrological Urology)
22 Cancer (EORTC - GU Group - European Organisation for Research and Treatment of Cancer -Genito-Urinary Group)
22 Female Urology (ESFU - European Society of Female Urology)
22 Infections in Urology (ESIU - European Society for Infections in Urology)
22 Male Genital Surgery and Reconstructive Urology (ESGURS - Eur. Soc. of Genito-Urinary Reconstructive Surgeons)
22 Neuro-urology (ESNU - European Society for Neuro Urology)
22 Oncological Urology (ESOU - European Society of Oncological Urology)
22 Paediatric Urology (ESPU - European Society for Paediatric Urology)
22 Transplantation Urology (ESTU - European Society of Transplantation Urology
22 Urolithiasis (EULIS - European Urolithiasis Society)
22 Urological Research (ESUR - European Society for Urological Research)
22 Urological Imaging (ESUI - European Society of Urological Imaging)
22 Urological Pathology (ESUP - European Society of Uro-Pathology)
22 Uro-Technology (ESUT - European Society of Uro-Technology)
Please return this application form to: European Association of Urology PO Box 30016 6803 AA Arnhem The NetherlandsF: +31 (0) 26 38 90 674 E: [email protected]
All members receive a subscription to: • European Urology (EAU Scientifi c Journal, 12 issues each year) • European Urology Today (EAU Newsletter, 4 issues each year) • European Urology Video Journal • Historia Urologiae Europaeae (one volume each year on European historical subjects) • Various annual publications