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Team Member Name

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Please fill out the following form prior to selecting a General or Premium Membership plan

First Name

Last Name

Email

Location

Profession * Required

Physician (e.g., MD, DO)

Scientist (e.g., PhD)

Nurse (e.g., NP, LPN, RN)

Physician assistant

Pharmacist

Student

Other

Specialty/subspecialty

Employer * Required

Academic institution

Private practice

Telemedicine

Pharmaceutical industry

Other healthcare institution

Other (non-healthcare)

Last update: Feb 2022

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