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* 1. General Information

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* 2. List your Board Certifications

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* 3. What is your medical specialty?

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* 4. What is your title in your current hospital role?

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* 5. Please select the choice that best describes your current status:

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* 6. If you are currently practicing, please describe your amount of clinical/administrative/teaching responsibilities (% of time).

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* 7. Current breast center affiliation?

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* 8. Are you a member of an accredited NAPBC breast center?

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