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Name
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Email
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ZIP Code
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Phone number
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Please check all that apply:
I am the spouse of a medical resident/fellow.
I am the spouse of an early career physician (1-5 years post training).
I am a parent.
I am part of a dual-career household.
I am part of a dual-physician household.
If you are a parent, what ages are your children?
Your answer
Please indicate which of the following aspects of the alliance interest you:
Legislative advocacy
Volunteer opportunities
Support in a new community
Networking opportunities
Fellowship from other physician spouses
Other:
What are some of your other personal interest?
We'd love to connect you with someone who shares your interests - be it cooking, biking, reading, crafting, etc!
Your answer
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