Up to 10 technologists will receive complimentary Annual Meeting registration. Preference will be given to AMP technologist members and those who have an accepted abstract.

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* 1. Name

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* 2. E-mail Address

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* 3. Supervisor's Name

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* 4. Supervisor's E-mail Address

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* 5. Employer/Institution

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* 6. City, State, Country

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* 7. My institution will not financially support my attendance at this event.

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* 8. Primary workplace setting (Please select one)

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* 9. I certify that I am currently an AMP Technologist.
NOTE: To renew your membership or to become a member, please go here.

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* 10. My AMP Member ID Number Is

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* 11. How will attending the Virtual AMP Annual Meeting and Expo enhance your professional development and/or trainee experience? [250 word limit]

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* 12. Have you submitted an abstract to the AMP Annual Meeting and Expo?

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* 13. If yes, are you the presenting author?

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* 14. Gender (Optional; choose one)

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* 15. Race/Ethnicity (Optional; choose one)

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* 16. In what year were you born? (Optional; enter 4-digit birth year; for example, 1976)

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