* 1. What is your name?

* 2. What is your e-mail address?

* 3. Are you a medical student, graduate student, health professions student, or post doc?

* 4. What year are you in your program?

* 5. Have you previously heard of Sheryl Sandberg's "Lean In?"

* 6. Would you be interested in joining a "Lean In" circle? More Information at http://leanin.org.