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Birthdate:(ex. 1/1/2001) |
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Office Address 1: |
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Undergraduate Training: |
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Graduate Training: |
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Medical Education: |
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Postgraduate Training: |
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Internship |
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Residency |
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Fellowship |
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Professional Societies: |
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Honors: |
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Board Certification: |
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Letter(s) of Recommendation: |
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Please forward: |
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Curriculum Vitae |
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One letter of recommendation written by your Chief of Urology
(or Dean of Medical School if you are the Chief) to: |
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Society of University Urologists
Membership Department
1100 E. Woodfield Rd., Suite 520
Schaumburg, IL 60173
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A bill for dues will be rendered upon election to membership. Do not enclose check. |
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