Membership Renewal

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Basic Research Investigator Initiated Clinical and Translational Research Industry Initiated Clinical and Translational Research Quality Improvement Research Other Research (example: healthcare delivery) Patient Care (includes administrative time) Teaching Administration that directly relates to pediatric endocrinology (excluding patient care) Other Specify Other Approximately how many patients do you see per week? Clinical Research Activities Other Interests Year Born Besides English, do you speak any other languages fluently? If yes, list the languages here Do you expect the balance of your activities (patient care, research, administration, etc.) to change in the next 5 years? If yes, how do you expect it to change? Are you planning to retire in the next 5 years? Gender Male Female Non-Binary/Gender Non-Conforming Prefer not to answer Ethnicity Hispanic Non-Hispanic Prefer not to answer You may publish my name, address, phone number, and email in the membership directory for members only. You may publish my name and address in the "Find a Doc" section of the web for public access. (Members’ email addresses will not be published on the public access section of the Website.)