SMRU and SREI Collaborative Exchange Program Application

The goal of the program is to bring together reproductive urologists and REIs from different practice settings or locations, as well as different backgrounds, to share knowledge and experience to meet the need of each member, with overarching goals to optimize complex challenging management scenarios, enhance diversity and to create new colleagues and collaborative relationships across our disciplines.  Each pair would individualize the plans in the collaborative exchange after their first meeting. 
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2.Applicant Information
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4.I am interested in collaborating with (check all that apply):(Required.)
5.I am interested in participating in the SMRU/SREI Collaborative Exchange Program to (check all that apply):
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