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SUNA Foundation uroLogic Registration Scholarship - Member 2+ years
The SUNA Foundation provides expenses up to a maximum of $1,500 for the annual uroLogic Conference, which will be reimbursed after submission accompanied by receipts for registration, travel, hotel, and meals. Any unused funds are non-transferable.
1.
Name, include credentials
2.
Street Address, City, State, Zip
3.
Phone (best way to reach you)
4.
Email Address:
5.
Active member of SUNA for at least 2 years?
Yes
No
6.
SUNA Member since?
7.
SUNA Activities (National, Regional and Chapter)
8.
CBUNA Certified?
Yes
No
9.
CBUNA Credential
10.
Education (Place, Graduation Year, Degrees, Certifications)
11.
Employment for the past 5 years (Name and position)
12.
Articles and/or Presentations in the past 5 years:
13.
Type of urologic care you provide:
14.
Describe your work setting, your role at work and how this conference will benefit 1) you and your personal growth, 2) benefits your practice, and 3) how information will be disseminated to other heal care team members. Please be specific but limit your comments to 350 words.
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