North Carolina Dermatology Association White Coat Day

We hope to see you there!

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* 1. Name

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* 2. Email

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* 3. Cell Phone Number

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* 4. Practice Affiliation/School

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* 5. Are you a...?

Student

Resident

Fellow

Physician

PA

Other

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* 6. Students, where do you go to school? What is your projected graduation date?

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* 7. Residents/Fellows, what is your projected last year of training?

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* 8. Do you plan to attend

yes

no

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* 9. Comments and/or questions