Thank you for your interest in volunteering with SIO. Please provide your information for SIO below.

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* 1. Please enter your information below:

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* 2. How many years have you been in practice?

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* 3. Currently, what is your primary medical setting? [Select one]

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* 4. Please indicate your areas of interest below. Please rank in order of interest with #1 being the most interesting, and #7 being of least interest.

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* 5. If there is another area of interest you have please list it here (if you have none please write "N/A"):

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* 6. Please indicate below if you have past or current experience in the following areas. Select all that apply:

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