PO Box 30016 6803 AA Arnhem The Netherlands

P +31 (0) 26 38 90 680 F +31 (0) 26 38 90 674

eau@uroweb.org 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: eau@uroweb.org

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