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* 1. Please write your name (including credentials)

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* 2. What is your email address?

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* 3. What is your place of employment?

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* 4. What is your specialty or area of focus? I.E Breast Cancer, Lymphoma, GU etc.

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* 5. Are you interested in serving on the Board of Directors if future positions become available?

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* 6. Are you interested in working with the Board of Directors on special projects or events, including special initiatives with FLASCO's Corporate Partners. 

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* 7. Are you interested in serving on the below committees?

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* 8. Would you like to serve as an Oncology Field Appointee if positions become available in the future? Please mark all that you would be eligible or interested in serving.

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* 9. For Fellows/Residents: Would you like to represent your learning institution?  Please mark which educational institution you are attending.

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* 10. For Fellows/Residents: would you like to represent your training specialty? Please mark which field of focused training you are interested in representing.

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* 11. Would you like to volunteer in a specialty interest group? Indicate which groups you would be interested in serving.

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* 12. Would you be interested in serving on the Advisory Panel in the FLASCO Forum?

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* 13. Where can FLASCO grow to better serve you as a member?

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* 14. How do you wish to receive your communications from FLASCO?

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