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* 1. First name

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* 2. Last name

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* 3. Email address

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* 4. Full name of practice and/or group

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* 5. Sub specialty

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* 6. Tenure

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* 7. What topics are you most interested in? (Please choose all that apply)

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* 8. Do you have any questions you'd like to ask the faculty? We will keep these anonymous if you request.

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* 9. Have you heard of SCA before?

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