Please fill out this form to allow us to better connect with members/interested parties and help us address your rural medical needs or interests.
Send any questions or thoughts to: youngruralsurgeons@gmail.com
Thank you!

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* 1. First name

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* 2. Last name

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* 3. Email address

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* 4. Where do you live?

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* 5. Area of specialty or interest? (e.g., surgery, internal medicine, pediatrics) 

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* 8. What areas of SYRUS interest you? (Please choose all that apply)

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* 9. What information from SYRUS would help you enhance your career/practice?

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* 10. Tell us about yourself!
How can SYRUS help you?
What are your career goals?
What hobbies/activities do you enjoy?

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