Thank you for attending the Coalition for Physician Enhancement (CPE) meeting in Winnipeg, Manitoba, Canada. If you wish to share your contact information with others who attended the conference, please complete this form. If you do not wish to share your contact information, please close the survey and do not complete.

My Name

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* 1. My Name

Please include the following contact information to be shared on the Coalition for Physician Enhancement Website (Click all that apply):

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* 2. Please include the following contact information to be shared on the Coalition for Physician Enhancement Website (Click all that apply):

Thank You

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