Chapter Book Club - Join

Please complete this brief form to join the Chapter Book Club.

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1. Full Name (Required.)

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2. Email Address (Required.)

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3. Where are you in your career?

Medical Student

Resident

Fellow

In practice less than or equal to 10 years

In practice greater than 10 years

Emeritus/Retired

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4. What do you hope to get out of this book club?

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5. What ideas do you have for this book club?
(e.g. goals, activities, etc.)

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6. Do you have any book recommendations?
If so, please list them below:

Thank you for joining! We will be in touch with you soon.