Member Demographic Survey (< 2 min)

Hi!  Welcome to the PEM CRC Survey Listserv.  We are collecting baseline demographic information from you to better characterize the Survey Listserv population in aggregate form.  This helps our survey Investigators describe the population of participants!  Thanks for your assistance.

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* 1. First Name

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* 2. Last Name

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* 3. What is your preferred e-mail address for survey studies?  (consider using a generic address - e.g. gmail / yahoo - if you anticipate switching institutions in the next 3 years)

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* 4. Geographical Region of Practice

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* 5. Primary Type of Training:

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* 6. Current majority Practice Setting

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* 7. Current majority Practice Setting

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* 8. What is your current role?

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* 9. Current Hospital Types of practice (select all that apply)

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