SIO Volunteer Interest Survey

Thank you for your interest in volunteering with SIO. Please provide your information below. This information will be used to identify opportunities for society engagement as needs arise.

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* 1. Please enter your information below:

Full Name

Pronouns

Credentials

Institution

Title

Preferred Phone Number

Preferred Email Address

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* 2. How many years have you been in practice?

I am currently a medical student, fellow or resident

1-5 years

6-10 years

11-15 years

15+ years

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* 3. What is your current primary medical setting? [Select one]

Community Hospital Setting

Academic Hospital Setting

Industry Partner

Private Practice

Retired

Other (please specify)

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* 4. Please indicate your areas of interest below. Please rank in order of interest with #1 being the most interesting, and #7 being of least interest.

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* 5. Please list any other areas of interest you have here. (if you have none please write "N/A"):

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* 6. Please indicate below if you have past or current experience in the following areas. Select all that apply:

Serving on a grant review panel

Clinical trial design & development

Registry design & development

Preclinical research

Education programming, including session or curriculum development

Resident programming

Not applicable