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.

First Name

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* 1. First Name

Last Name

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* 2. Last Name

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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* 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)

Geographical Region of Practice

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* 4. Geographical Region of Practice

Primary Type of Training:

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* 5. Primary Type of Training:

Current majority Practice Setting

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* 6. Current majority Practice Setting

Current majority Practice Setting

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* 7. Current majority Practice Setting

What is your current role?

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* 8. What is your current role?

Current Hospital Types of practice (select all that apply)

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

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