Partner, Spouse & Family Network Membership Form

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Partner, Spouse & Family Network Membership Form - 2022/2023

We are trying something new this year and not having any membership fees! Rather, when we have events, we will have those that are able to attend chip in a small amount or provide a dish to share, for example. It'll be a "pay as you come" year while we continue to try new things!

Membership questions email chelseabiggs33@gmail.com or shannonclouse14@gmail.com

Email *

First Name *

Last Name *

Mailing Address *

phone number *

Occupation of PSF member (you!) *

Resident/Fellow's Department *

Name of Resident/Fellow

Resident/Fellow’s year and expected graduation at UC Davis *

Children’s names and ages (if applicable) *

Food Allergies of Member? If yes, what allergy? *

Birthday of member *

YYYY

Can we share your information with other PSF members and to the Graduate Medical Education Office?

YES

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