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CGRN Membership: Personal Information
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First Name
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Your answer
Last Name
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Your answer
Designation (MD, PhD, etc.)
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Your answer
Email
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Your answer
Phone Number
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Your answer
Role (Professor, Associate, Assistant, etc.)
Your answer
Specialty (Select All That Apply)
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If you do not see your specialty or specialities below, please select "Other" and type in your specialties.
Pediatric Glaucoma
Glaucoma
Pediatric Ophthalmology
I am currently a Resident or Fellow
I am not a medical professional (see next item)
Other:
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Industry
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