IUGA Speaker Interest Form

IUGA Speaker Interest Form
Name*

First NameLast NameDegree
Email*
example@example.com
Native Language
Languages Fluent In
Country of Residence*
I can present in the following topical areas (check all that apply)*

Urinary incontinenceVoiding dysfunctionAnal incontinenceGenital tract fistulae (etiology and management)ProlapseRecurrent UTIBladder pain syndromesFemale sexual functionImaging in urogynecology
Urinary incontinence (check all that apply)

TypePathophysiologyConservative managementMedical treatmentSurgical managementThird line treatmentsRefractory patientsSalvage surgery
Voiding dysfunction (check all that apply)

PathophysiologyManagementCatheters
Anal incontinence (check all that apply)

PathophysiologyManagementPreventionSurgical treatment
Prolapse (check all that apply)

PathophysiologyPreventionConservative managementSurgical managementSurgical complicationsRecurrent prolapse
I have specific interest in presenting on:
Please indicate the topics, expertise and/or skills that you can present on.
If you have a short video clip of a presentation that demonstrates your presenting skills, please send it to us at education@iuga.org. If the file is too large to send, you can send it to us using the free online transfer service at https://iuga.wetransfer.com

Be sure that the receiving email is to set to be wetransfer@iuga.org.
Should be Empty: