Nominate a Queer Doctor

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Nominate a queer doctor or scientist to be on the pod!

* Indicates required question

Nominee Name *

Your answer

Nominee Field of Medicine/Study *

Your answer

Nominee Email Address *

Your answer

Is this person available to reach by phone? *

Yes

No

Required

If so list number below

Your answer

Nominee pronouns *

Your answer

Any other relevant details?

Your answer

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