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* 1. Name and Degrees (example: Gary Hammer, MD, PhD)

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* 2. Institution

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* 3. Email Address

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* 4. Twitter Handle

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* 5. Facebook Handle

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* 6. Instagram Handle

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* 7. Brief Biography

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* 8. Please upload a photo of yourself. 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 9. What is your favorite Endocrine Society memory? How has Endocrine Society supported your professional journey?

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* 10. Why did you become an endocrinologist? Did a particular experience lead you here?

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* 11. What would you most like to tell yourself at 18?

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* 12. I consent to Endocrine Society using the contents of this submission in marketing materials to convey the member experience.