Up to 10 trainees (Residents, Fellows, and Students) will receive complimentary Annual Meeting registration. Preference will be given to AMP associate 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. Current Trainee Position (e.g. PGY3, MGP Fellow, LGG Fellow)

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* 4. Mentor/Supervisor's Name

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* 5. Mentor/Supervisor's E-mail Address

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* 6. Employer/Institution

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* 7. City, State, Country

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* 8. Primary Degree (Please select one)

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* 9. Primary workplace setting (Please select one)

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* 10. I certify that I am currently an AMP Associate (Trainee) Member.
NOTE: To renew your membership or to become a member, please go here.

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* 11. My AMP Member ID Number Is

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

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

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* 15. Gender (Optional; choose one)

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

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

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