Applications for membership are considered at each of the two biannual meetings. Applications submitted until October 1, 2009, will be considered at the 43rd Biannual Meeting on October 16th, 2009.

Current pediatric urology fellows are granted honorary membership as fellow members and must then apply for full membership after completion of their fellowship.

Download application
You may download the application as a Microsoft Word document, complete it,and e-mail it along with a current CV to Betty Hardin. (betty.hardin@chsys.org)

To apply for membership, complete this form then print and mail to the address below.
Please note: a current CV must accompany application for membership

Name:	(Last) (First) (M.I.)

Mailing Address:
Institution
Address:
City:
State/Providence:
Country
ZIP/Postal Code

Telephone: (Please note country code if non-U.S.):
Fax:
Email Address:

Medical Education
Medical School
Location/Date
Residency
Location/Date
Fellowship
Location/Date

Board Certification:
No	Yes: Specify: Date:
State/Country of Licensure
	Please note: a current CV must accompany the printed application for membership. Use the mailing address below.

Curent pediatric urology fellows cannot be considered for Full Membership until completion of their fellowship. Fellows may submit their names and contact information for listing as Fellow Members.