Please fill in the information below. If entering competition solo, skip questions 3-4.

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* 1. Team member #1 Last Name:

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* 2. Team Member #1 First name:

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* 3. What is your email address?

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* 4. Team Member #2 Last name:

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* 5. Team member #2 First Name:

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* 6. What is your email address?

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* 7. Are you a medical student or resident?

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* 8. With what institution are you associated?

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* 9. Please create a unique Team Name with a minimum of 5 letters and/or digits.

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