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* 1. Contact Information

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* 2. Medical School/ Residency Year

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* 3. Name of Medical School or Residency

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* 4. Branch of Service

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* 5. Accommodations

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* 6. Each student or resident will share a room with another student or resident. If you have a preference for a roommate, please enter that name in the text field below. If you need special accommodations, please let us know the nature of your needs in the text field below.

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* 7. If you need accommodations, please enter your arrival and departure dates.

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Date

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* 8. Have you been accepted to present at the Conference?

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* 9. Please state why you would like to attend the 2023 USAFP Annual Meeting. (Limit 250 words)

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