Chapter Book Club - Join

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

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* 1. Full Name

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* 2. Email Address

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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.