Family Medicine Clerkship March EOQ Meeting 2019

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* 1. What is your name?

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* 2. Will you be attending the event?

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* 3. If you will not be attending the event, will someone else from your site attend in your place? If you are not attending the event, please explain why.

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* 4. If attending, please provide:
Your name

Your professional title

The name and location of your clerkship site.  

We will use this information to generate your name tag.

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* 5. Do you have any dietary restrictions?

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* 6. What is the best email and phone number to reach you?

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