BAUS North West Urology Research Collaborative Interest Form

BAUS North West Urology Research Collaborative Interest Form

Register your interest in joining the regional research collaborative and submitting data on urological conditions.
Full Name*

First NameLast Name
Email Address*
example@example.com
Current Trust or Hospital*
Professional Role/Title*
Are you interested in participating in the North West Urology Research Collaborative?*

YesNo
Which of the following urological conditions do you currently manage or have clinical involvement with? (Select all that apply)*

Prostate cancerBladder cancerKidney cancerTesticular cancerUrinary tract infectionsBenign prostatic hyperplasia (BPH)Urinary incontinenceUrolithiasis (kidney stones)Paediatric urologyAndrologyFunctional urologyOther
Please provide any additional comments, interests, or relevant experience (optional)
Would you be interested in joining the BAUS North West Urology Research Collaborative committee?*

YesNo
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