Credentials & Certifications:
AUA ID Number (if known):
Are you a member of an AUA Section?:
If yes, what AUA Section are you a member of?:
Employer Address 2:
Name of Undergraduate Institution:
Name of Graduate Institution:
Years in Practice:
Years in Urology:
Areas of Expertise:
Integration/Utilization of Advanced Practice Providers
Upper Tract Obstruction
Additional details about areas of expertise:
Provide a brief Bio (Maximum 250 words):
Letter(s) of Recommendation (One must be from a current AUA Member):
If you have any additional Letters of Recommendation or Speaker Evaluations that you would like to include, please email them to
Why do you want to be on the AUA Speakers Bureau? (Maximum 250 words):
Do you have any special requirements? (Note: The AUA and each AUA Section have their own travel and honoraria policies.)
Distance of travel?:
Amount of Lead Time?:
AUA's APP Speaker's Bureau Agreement
As a speaker for the American Urological Association (AUA), you are required to:
Maintain an active AUA membership status.
Notify the AUA of any changes to employment at
education@AUAnet.org. Respond promptly to inquiries from AUA or AUA Sections regarding speaking availability.
Adhere to the AUA Speaker Guidelines outlined below.
Continuing medical education (CME) consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. The content of CME is that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public.
The AUA Office of Education requires anyone who is the position to control the content of an accredited CME activity [e.g. scientific program directors, faculty presenters, speakers, moderators, program planners, contributors, editors and presenting authors]:
Must not be employed full-time by an ACCME-defined commercial interest [industry] at any time during the planning or presentation of a CME activity.
Employees of ACCME-defined commercial interests can control the content of accredited CME activities when the content of the CME activity is not related to the business lines or products of their employer.
Employees of ACCME-commercial interests can control the content of accredited CME activities (e.g., as planners, authors, or speakers [including poster presentations]) when the content of the accredited CME activity is limited to basic science research (e.g., pre-clinical research, drug discovery) or the processes/methodologies of research, themselves unrelated to a specific disease or compound/drug. In these circumstances, the AUA Office of Education must be able to demonstrate that it has implemented processes to ensure employees of ACCME-defined commercial interests have no control of CME activity content that is related to clinical applications of the research/discovery or clinical recommendations concerning the business lines or products of their employer.
Disclose all relevant financial relationships with any commercial interest.
Please remember that your disclosure must be made
within 12 months before the activity. If you have not already done so, please update your disclosures: www.auanet.org/coi. Base all the recommendations involving clinical medicine on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
Ensure that all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis.
Provide strong support from the overall body of evidence if claiming the superiority of one technology, program, product, device, drug or service over another.
Discuss positive and negative information in an intellectually informative and balanced manner using the highest level of evidence available.
Refrain from recommendations, treatments, or manners of practicing medicine that are not within the ACCME definition of CME (above), are known to have risks or dangers that outweigh benefits, or are known to be ineffective.
Develop content that promotes improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Present a balanced view of therapeutic options. Use generic names when speaking about technologies, programs, products, devices, drugs and/or services; use trade names only for clarification.
Refrain from discussing consulting/referral-related services or distributing promotional materials at the activity.
Receive no payments for participation with the exception of those provided by AUA.
Refrain from speaking at an industry sponsored non-CME activity held during the program.
I have read and agree to abide by these guidelines in my contributions to AUA CME activities.