This questionnaire will help the FSP understand your leadership interests for serving on the Resident and Fellow Committee. 


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* 1. Full Name

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* 2. Email Address 

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* 3. Phone Number 

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* 4. Training Status

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* 5. What position are you interested in serving?

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* 6. Please share why you would like to be considered for nomination.

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* 7. What other professional organizations do you belong to?

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* 8. Are you currently serving in any leadership roles?

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