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HAPC Voices Panel
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1.
Applicant Full Name and Credentials
(Required.)
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2.
Pronouns
(Required.)
She, Her, Hers
He, Him, His
They, Them, Theirs
Ze (or Zie)/Hir/Hirs
Xie/Hir/Hirs
Co/Co/Cos
En/En/Ens
Ey/Em/Eirs
Yo/Yo/Yos
Ve/Vis/Ver
No pronouns, please use my name instead
Prefer Not to Answer
Prefer to Self-Describe
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3.
Job Title and Position
(Required.)
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4.
Preferred Mailing Address
(Required.)
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5.
City, State and Zip
(Required.)
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6.
Please indicate whether your address is
(Required.)
Home
Work
Other (please specify)
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7.
Phone
(Required.)
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8.
Email
(Required.)
9.
Are you a member of AAHPM?
Yes
No
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