UAA

Account Name

password

First Name

Middle Name

Last Name

Country of Residence

Date of Birth

Phone

Institution

Current appointment

Mailing Address

Postal Code

Urological Qualification: 1

Year

Urological Qualification: 2

Year2

Urological Qualification: 3

Year3

Area of specialty: 1

Area of specialty: 2

Area of specialty: 3

Membership Type of Urological Association of Asia (tick one) *

Full Individual Member (Certified urologist from any Asian country)
Associate Individual Member (Trainee in Urology from any Asian country)
Affiliated Individual Member (Qualified urologist from outside Asia, physician related to the field of Urology,
researcher doing research in the field of Urology, nurse related to the field of Urology)

Current Membership Status at National Association *

I am currently a

Member of my National Association.

I am currently not a member of my National Association.

Upload the endorsement letter (or email) to prove you are a member of your national association. If you don't upload now, you must upload or send via email within 2 weeks after submission. (file must under 5Mb)

Subscription to the International Journal of Urology (IJU), Official Journal of UAA *

I would like to subscribe @ USD28.00 per annum.
I do not wish to subscribe.

Important Note :

1. Currently, UAA do not collect any membership fee from its members. UAA reserves the right to implement membership subscription as to when it deem fit.

2. UAA Individual Member does not have voting rights.

** By clicking “Submit”, you agree that the above information is correct and true. You also consent to UAA using your personal data to perform obligations in the course of or in connection with the UAA’s activities and/or other organizations who have been engaged to perform functions relating to the Core Purpose of UAA.

Individual Membership Application Form