Get Involved

Get Involved

Volunteer Form

 

Please complete this form and your information will be forwarded to the Section leadership, or in some cases to the AUA.

 

Name (including middle initial): *
Position Considered & Year of Office:
Address:
Address 2:
City:
State:
Zip:
Country:
Email:
Board Certification Year:
Year Joined AUA & Northeastern Section
Please list any involvement you have (past and present) with the Northeastern Section
(e.g. position(s) held and year, papers presented, meetings attended, etc.):

Please list any involvement you have (past and present) with the National Office of the American Urological Association (e.g. position(s) held and year, papers presented, meetings attended, etc.):
Please list any involvement you have (past and present) with other urological or medical organizations (e.g. AACU, ACS, AMA, ABU, AUAF, hospitals, county and/or state organizations, etc.):
Please list any Academic Positions/ Appointments/ Committees:
Please list any non-medical leadership affiliations or involvement (e.g. philanthropic, civic, service clubs, religious, commercial, political, etc.):
Briefly state why you should be considered as a candidate for this position: