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Heart Tank for the Cardiovascular Investigator - Imaging
1.
Name
2.
Email address
3.
Name of Mentor
4.
Institution
5.
Location (city, state)
6.
Year in Training
7.
General or subspecialty fellow (if subspecialty, specify)
8.
Gender
Male (includes transgender male)
Female (includes transgender female)
Prefer to self-identify (non-binary, gender fluid, agender)
9.
Race/Ethnicity
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Decline to Provide
Other (please specify)
Current Progress,
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