ACP NM Early Career 2022

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* 1. Name (Including MD/DO/Credentials)

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* 2. Current Position & Institution/Practice:

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* 3. Email address

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* 4. City You Live/Practice

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* 5. I am interested in

In-Person Events

Virtual Events

Mix of In-Person/Virtual

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* 6. Please rate your interest in the following programming

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* 7. Please rate your interest in the following programming

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* 8. Any topics/programs you are interested in:

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* 9. Interested in Judging Resident/Student Abstracts or Posters?

Yes

No