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* 1. Choose your specialty:

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* 2. Enter your name:

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* 3. Enter your email address:

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* 4. Select your Primary Care Practice:

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* 5. Select your Specialty Care Practice:

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* 6. Watch the 'TCCN State of the Union Video': Enter one of the presenters in the text box.  TCCN State of the Union Video

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* 7. By submitting this survey, I attest that I watched the 'TCCN State of the Union Video'

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