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* 1. Name

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* 2. Email address

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* 3. Are you currently serving on an AANN or ABNN Committee (s)? If yes, please enter the name of the committee below.

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* 4. Considering 100% of your time working, please provide a representation by percentage of your time spent in the following specialty areas of practice (total should = 100%). If patients fit in more than one area, please select their primary problem.

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* 5. Considering 100% of your time working, please provide a representation by percentage of the age group of individuals for whom you care/treat/study (total should = 100%).

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* 6. Considering 100% of your time working, please provide a representation by percentage of the location of your practice (total should = 100%).

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* 7. Considering 100% of your time working, please provide a representation by percentage of the responsibility you have (total should = 100%).

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* 8. Considering 100% of your time working, please provide a representation by percentage of the setting in which you work (total should = 100%).

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