Please complete this brief form to join the AAPCA1 Practice Support Task Force. 

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* 1. Practice Setting:

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* 2. Where are you in your career?

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* 3. Specialist vs Primary Care (please select one)

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* 4. What do you hope to get out of this task force?

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* 5. What ideas do you have for this task force? 
(e.g. goals, activities, etc.)

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* 6. Full Name

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* 7. Email Address

Thank you for joining! We will be in touch with you soon.
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