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Island</option> <option value="tfa_1375" id="tfa_1375" class="">Northern Mariana Islands</option> <option value="tfa_1376" id="tfa_1376" class="">Guam</option> <option value="tfa_1377" id="tfa_1377" class="">American Samoa</option> <option value="tfa_1378" id="tfa_1378" class="">Palau</option></select></div> </div> <div class="oneField field-container-D " id="tfa_1079-D"> <label id="tfa_1079-L" class="label preField reqMark" for="tfa_1079">Country</label><br><div class="inputWrapper"><select aria-required="true" id="tfa_1079" name="tfa_1079" title="Country" class="required"><option value="">Please select...</option> <option value="tfa_1080" id="tfa_1080" class="">Afghanistan</option> <option value="tfa_1081" id="tfa_1081" class="">Albania</option> <option value="tfa_1082" id="tfa_1082" class="">Algeria</option> <option value="tfa_1083" id="tfa_1083" class="">American Samoa</option> <option value="tfa_1084" id="tfa_1084" class="">Andorra</option> <option value="tfa_1085" id="tfa_1085" class="">Angola</option> <option value="tfa_1086" id="tfa_1086" class="">Anguilla</option> <option value="tfa_1087" id="tfa_1087" class="">Antarctica</option> <option value="tfa_1088" id="tfa_1088" class="">Antigua and Barbuda</option> <option value="tfa_1089" id="tfa_1089" class="">Argentina</option> <option value="tfa_1090" id="tfa_1090" class="">Armenia</option> <option value="tfa_1091" id="tfa_1091" class="">Aruba</option> <option value="tfa_1092" id="tfa_1092" class="">Australia</option> <option value="tfa_1093" id="tfa_1093" class="">Austria</option> <option value="tfa_1094" id="tfa_1094" class="">Azerbaijan</option> <option value="tfa_1095" id="tfa_1095" class="">Bahamas</option> <option value="tfa_1096" id="tfa_1096" class="">Bahrain</option> <option value="tfa_1097" id="tfa_1097" class="">Bangladesh</option> <option value="tfa_1098" id="tfa_1098" class="">Barbados</option> <option value="tfa_1099" id="tfa_1099" class="">Belarus</option> <option value="tfa_1100" id="tfa_1100" class="">Belgium</option> <option value="tfa_1101" id="tfa_1101" class="">Belize</option> <option value="tfa_1102" id="tfa_1102" class="">Benin</option> <option value="tfa_1103" id="tfa_1103" class="">Bermuda</option> <option value="tfa_1104" id="tfa_1104" class="">Bhutan</option> <option value="tfa_1105" id="tfa_1105" class="">Bolivia</option> <option value="tfa_1106" id="tfa_1106" class="">Bosnia and Herzegovina</option> <option value="tfa_1107" id="tfa_1107" class="">Botswana</option> <option value="tfa_1108" id="tfa_1108" class="">Bouvet Island</option> <option value="tfa_1109" id="tfa_1109" class="">Brazil</option> <option value="tfa_1110" id="tfa_1110" class="">British Indian Ocean Territory</option> <option value="tfa_1111" id="tfa_1111" class="">Brunei</option> <option value="tfa_1112" id="tfa_1112" class="">Bulgaria</option> <option value="tfa_1113" id="tfa_1113" class="">Burkina Faso</option> <option value="tfa_1114" id="tfa_1114" class="">Burundi</option> <option value="tfa_1115" id="tfa_1115" class="">Cambodia</option> <option value="tfa_1116" id="tfa_1116" class="">Cameroon</option> <option value="tfa_1117" id="tfa_1117" class="">Canada</option> <option value="tfa_1118" id="tfa_1118" class="">Cape Verde</option> <option value="tfa_1119" id="tfa_1119" class="">Cayman Islands</option> <option value="tfa_1120" id="tfa_1120" class="">Central African Republic</option> <option value="tfa_1121" id="tfa_1121" class="">Chad</option> <option value="tfa_1122" id="tfa_1122" class="">Chile</option> <option value="tfa_1123" id="tfa_1123" class="">China</option> <option value="tfa_1124" id="tfa_1124" class="">Christmas Island</option> <option value="tfa_1125" id="tfa_1125" class="">Cocos ( Keeling ) Islands</option> <option value="tfa_1126" id="tfa_1126" class="">Colombia</option> <option value="tfa_1127" id="tfa_1127" class="">Comoros</option> <option value="tfa_1128" id="tfa_1128" class="">Congo</option> <option value="tfa_1129" id="tfa_1129" class="">Cook Islands</option> <option value="tfa_1130" id="tfa_1130" class="">Costa Rica</option> <option value="tfa_1131" id="tfa_1131" class="">C脙麓te d ' Ivoire</option> <option value="tfa_1132" id="tfa_1132" class="">Croatia ( Hrvatska )</option> <option value="tfa_1133" id="tfa_1133" class="">Cuba</option> <option value="tfa_1134" id="tfa_1134" class="">Cyprus</option> <option value="tfa_1135" id="tfa_1135" class="">Czech Republic</option> <option value="tfa_1136" id="tfa_1136" class="">Congo ( DRC )</option> <option value="tfa_1137" id="tfa_1137" class="">Denmark</option> <option value="tfa_1138" id="tfa_1138" class="">Djibouti</option> <option value="tfa_1139" id="tfa_1139" class="">Dominica</option> <option value="tfa_1140" id="tfa_1140" class="">Dominican Republic</option> <option value="tfa_1141" id="tfa_1141" class="">East Timor</option> <option value="tfa_1142" id="tfa_1142" class="">Ecuador</option> <option value="tfa_1143" id="tfa_1143" class="">Egypt</option> <option value="tfa_1144" id="tfa_1144" class="">El Salvador</option> <option value="tfa_1145" id="tfa_1145" class="">Equatorial Guinea</option> <option value="tfa_1146" id="tfa_1146" class="">Eritrea</option> <option value="tfa_1147" id="tfa_1147" class="">Estonia</option> <option value="tfa_1148" id="tfa_1148" class="">Ethiopia</option> <option value="tfa_1149" id="tfa_1149" class="">Falkland Islands ( Islas Malvinas )</option> <option value="tfa_1150" id="tfa_1150" class="">Faroe Islands</option> <option value="tfa_1151" id="tfa_1151" class="">Fiji Islands</option> <option value="tfa_1152" id="tfa_1152" class="">Finland</option> <option value="tfa_1153" id="tfa_1153" class="">France</option> <option value="tfa_1154" id="tfa_1154" class="">French Guiana</option> <option value="tfa_1155" id="tfa_1155" class="">French Polynesia</option> <option value="tfa_1156" id="tfa_1156" class="">French Southern and Antarctic Lands</option> <option value="tfa_1157" id="tfa_1157" class="">Gabon</option> <option value="tfa_1158" id="tfa_1158" class="">Gambia</option> <option value="tfa_1159" id="tfa_1159" class="">Georgia</option> <option value="tfa_1160" id="tfa_1160" class="">Germany</option> <option value="tfa_1161" id="tfa_1161" class="">Ghana</option> <option value="tfa_1162" id="tfa_1162" class="">Gibraltar</option> <option value="tfa_1163" id="tfa_1163" class="">Greece</option> <option value="tfa_1164" id="tfa_1164" class="">Greenland</option> <option value="tfa_1165" id="tfa_1165" class="">Grenada</option> <option value="tfa_1166" id="tfa_1166" class="">Guadeloupe</option> <option value="tfa_1167" id="tfa_1167" class="">Guam</option> <option value="tfa_1168" id="tfa_1168" class="">Guatemala</option> <option value="tfa_1169" id="tfa_1169" class="">Guinea</option> <option value="tfa_1170" id="tfa_1170" class="">Guinea-Bissau</option> <option value="tfa_1171" id="tfa_1171" class="">Guyana</option> <option value="tfa_1172" id="tfa_1172" class="">Haiti</option> <option value="tfa_1173" id="tfa_1173" class="">Heard Island and McDonald Islands</option> <option value="tfa_1174" id="tfa_1174" class="">Honduras</option> <option value="tfa_1175" id="tfa_1175" class="">Hong Kong SAR</option> <option value="tfa_1176" id="tfa_1176" class="">Hungary</option> <option value="tfa_1177" id="tfa_1177" class="">Iceland</option> <option value="tfa_1178" id="tfa_1178" class="">India</option> <option value="tfa_1179" id="tfa_1179" class="">Indonesia</option> <option value="tfa_1180" id="tfa_1180" class="">Iran</option> <option value="tfa_1181" id="tfa_1181" class="">Iraq</option> <option value="tfa_1182" id="tfa_1182" class="">Ireland</option> <option value="tfa_1183" id="tfa_1183" class="">Israel</option> <option value="tfa_1184" id="tfa_1184" class="">Italy</option> <option value="tfa_1185" id="tfa_1185" class="">Jamaica</option> <option value="tfa_1186" id="tfa_1186" class="">Japan</option> <option value="tfa_1187" id="tfa_1187" class="">Jordan</option> <option value="tfa_1188" id="tfa_1188" class="">Kazakhstan</option> <option value="tfa_1189" id="tfa_1189" class="">Kenya</option> <option value="tfa_1190" id="tfa_1190" class="">Kiribati</option> <option value="tfa_1191" id="tfa_1191" class="">Korea</option> <option value="tfa_1192" id="tfa_1192" class="">Kuwait</option> <option value="tfa_1193" id="tfa_1193" class="">Kyrgyzstan</option> <option value="tfa_1194" id="tfa_1194" class="">Laos</option> <option value="tfa_1195" id="tfa_1195" class="">Latvia</option> <option value="tfa_1196" id="tfa_1196" class="">Lebanon</option> <option value="tfa_1197" id="tfa_1197" class="">Lesotho</option> <option value="tfa_1198" id="tfa_1198" class="">Liberia</option> <option value="tfa_1199" id="tfa_1199" class="">Libya</option> <option value="tfa_1200" id="tfa_1200" class="">Liechtenstein</option> <option value="tfa_1201" id="tfa_1201" class="">Lithuania</option> <option value="tfa_1202" id="tfa_1202" class="">Luxembourg</option> <option value="tfa_1203" id="tfa_1203" class="">Macao SAR</option> <option value="tfa_1204" id="tfa_1204" class="">Macedonia, Former Yugoslav Republic of</option> <option value="tfa_1205" id="tfa_1205" class="">Madagascar</option> <option value="tfa_1206" id="tfa_1206" class="">Malawi</option> <option value="tfa_1207" id="tfa_1207" class="">Malaysia</option> <option value="tfa_1208" id="tfa_1208" class="">Maldives</option> <option value="tfa_1209" id="tfa_1209" class="">Mali</option> <option value="tfa_1210" id="tfa_1210" class="">Malta</option> <option value="tfa_1211" id="tfa_1211" class="">Marshall Islands</option> <option value="tfa_1212" id="tfa_1212" class="">Martinique</option> <option value="tfa_1213" id="tfa_1213" class="">Mauritania</option> <option value="tfa_1214" id="tfa_1214" class="">Mauritius</option> <option value="tfa_1215" id="tfa_1215" class="">Mayotte</option> <option value="tfa_1216" id="tfa_1216" class="">Mexico</option> <option value="tfa_1217" id="tfa_1217" class="">Micronesia</option> <option value="tfa_1218" id="tfa_1218" class="">Moldova</option> <option value="tfa_1219" id="tfa_1219" class="">Monaco</option> <option value="tfa_1220" id="tfa_1220" class="">Mongolia</option> <option value="tfa_1221" id="tfa_1221" class="">Montserrat</option> <option value="tfa_1222" id="tfa_1222" class="">Morocco</option> <option value="tfa_1223" id="tfa_1223" class="">Mozambique</option> <option value="tfa_1224" id="tfa_1224" class="">Myanmar</option> <option value="tfa_1225" id="tfa_1225" class="">Namibia</option> <option value="tfa_1226" id="tfa_1226" class="">Nauru</option> <option value="tfa_1227" id="tfa_1227" class="">Nepal</option> <option value="tfa_1228" id="tfa_1228" class="">Netherlands</option> <option value="tfa_1229" id="tfa_1229" class="">Netherlands Antilles</option> <option value="tfa_1230" id="tfa_1230" class="">New Caledonia</option> <option value="tfa_1231" id="tfa_1231" class="">New Zealand</option> <option value="tfa_1232" id="tfa_1232" class="">Nicaragua</option> <option value="tfa_1233" id="tfa_1233" class="">Niger</option> <option value="tfa_1234" id="tfa_1234" class="">Nigeria</option> <option value="tfa_1235" id="tfa_1235" class="">Niue</option> <option value="tfa_1236" id="tfa_1236" class="">Norfolk Island</option> <option value="tfa_1237" id="tfa_1237" class="">North Korea</option> <option value="tfa_1238" id="tfa_1238" class="">Northern Mariana Islands</option> <option value="tfa_1239" id="tfa_1239" class="">Norway</option> <option value="tfa_1240" id="tfa_1240" class="">Oman</option> <option value="tfa_1241" id="tfa_1241" class="">Pakistan</option> <option value="tfa_1242" id="tfa_1242" class="">Palau</option> <option value="tfa_1243" id="tfa_1243" class="">Panama</option> <option value="tfa_1244" id="tfa_1244" class="">Papua New Guinea</option> <option value="tfa_1245" id="tfa_1245" class="">Paraguay</option> <option value="tfa_1246" id="tfa_1246" class="">Peru</option> <option value="tfa_1247" id="tfa_1247" class="">Philippines</option> <option value="tfa_1248" id="tfa_1248" class="">Pitcairn Islands</option> <option value="tfa_1249" id="tfa_1249" class="">Poland</option> <option value="tfa_1250" id="tfa_1250" class="">Portugal</option> <option value="tfa_1251" id="tfa_1251" class="">Puerto Rico</option> <option value="tfa_1252" id="tfa_1252" class="">Qatar</option> <option value="tfa_1253" id="tfa_1253" class="">Reunion</option> <option value="tfa_1254" id="tfa_1254" class="">Romania</option> <option value="tfa_1255" id="tfa_1255" class="">Russia</option> <option value="tfa_1256" id="tfa_1256" class="">Rwanda</option> <option value="tfa_1257" id="tfa_1257" class="">Samoa</option> <option value="tfa_1258" id="tfa_1258" class="">San Marino</option> <option value="tfa_1259" id="tfa_1259" class="">S脙拢o Tom脙漏 and Pr脙卢ncipe</option> <option value="tfa_1260" id="tfa_1260" class="">Saudi Arabia</option> <option value="tfa_1261" id="tfa_1261" class="">Senegal</option> <option value="tfa_1262" id="tfa_1262" class="">Serbia and Montenegro</option> <option value="tfa_1263" id="tfa_1263" class="">Seychelles</option> <option value="tfa_1264" id="tfa_1264" class="">Sierra Leone</option> <option value="tfa_1265" id="tfa_1265" class="">Singapore</option> <option value="tfa_1266" id="tfa_1266" class="">Slovakia</option> <option value="tfa_1267" id="tfa_1267" class="">Slovenia</option> <option value="tfa_1268" id="tfa_1268" class="">Solomon Islands</option> <option value="tfa_1269" id="tfa_1269" class="">Somalia</option> <option value="tfa_1270" id="tfa_1270" class="">South Africa</option> <option value="tfa_1271" id="tfa_1271" class="">South Georgia and the South Sandwich Islands</option> <option value="tfa_1272" id="tfa_1272" class="">Spain</option> <option value="tfa_1273" id="tfa_1273" class="">Sri Lanka</option> <option value="tfa_1274" id="tfa_1274" class="">St. Helena</option> <option value="tfa_1275" id="tfa_1275" class="">St. Kitts and Nevis</option> <option value="tfa_1276" id="tfa_1276" class="">St. Lucia</option> <option value="tfa_1277" id="tfa_1277" class="">St. Pierre and Miquelon</option> <option value="tfa_1278" id="tfa_1278" class="">St. Vincent and the Grenadines</option> <option value="tfa_1279" id="tfa_1279" class="">Sudan</option> <option value="tfa_1280" id="tfa_1280" class="">Suriname</option> <option value="tfa_1281" id="tfa_1281" class="">Svalbard and Jan Mayen</option> <option value="tfa_1282" id="tfa_1282" class="">Swaziland</option> <option value="tfa_1283" id="tfa_1283" class="">Sweden</option> <option value="tfa_1284" id="tfa_1284" class="">Switzerland</option> <option value="tfa_1285" id="tfa_1285" class="">Syria</option> <option value="tfa_1286" id="tfa_1286" class="">Taiwan</option> <option value="tfa_1287" id="tfa_1287" class="">Tajikistan</option> <option value="tfa_1288" id="tfa_1288" class="">Tanzania</option> <option value="tfa_1289" id="tfa_1289" class="">Thailand</option> <option value="tfa_1290" id="tfa_1290" class="">Togo</option> <option value="tfa_1291" id="tfa_1291" class="">Tokelau</option> <option value="tfa_1292" id="tfa_1292" class="">Tonga</option> <option value="tfa_1293" id="tfa_1293" class="">Trinidad and Tobago</option> <option value="tfa_1294" id="tfa_1294" class="">Tunisia</option> <option value="tfa_1295" id="tfa_1295" class="">Turkey</option> <option value="tfa_1296" id="tfa_1296" class="">Turkmenistan</option> <option value="tfa_1297" id="tfa_1297" class="">Turks and Caicos Islands</option> <option value="tfa_1298" id="tfa_1298" class="">Tuvalu</option> <option value="tfa_1299" id="tfa_1299" class="">Uganda</option> <option value="tfa_1300" id="tfa_1300" class="">Ukraine</option> <option value="tfa_1301" id="tfa_1301" class="">United Arab Emirates</option> <option value="tfa_1302" id="tfa_1302" class="">United Kingdom</option> <option value="tfa_1303" id="tfa_1303" class="">United States</option> <option value="tfa_1304" id="tfa_1304" class="">United States Minor Outlying Islands</option> <option value="tfa_1305" id="tfa_1305" class="">Uruguay</option> <option value="tfa_1306" id="tfa_1306" class="">Uzbekistan</option> <option value="tfa_1307" id="tfa_1307" class="">Vanuatu</option> <option value="tfa_1308" id="tfa_1308" class="">Vatican City</option> <option value="tfa_1309" id="tfa_1309" class="">Venezuela</option> <option value="tfa_1310" id="tfa_1310" class="">Viet Nam</option> <option value="tfa_1311" id="tfa_1311" class="">Virgin Islands ( British )</option> <option value="tfa_1312" id="tfa_1312" class="">Virgin Islands</option> <option value="tfa_1313" id="tfa_1313" class="">Wallis and Futuna</option> <option value="tfa_1314" id="tfa_1314" class="">Yemen</option> <option value="tfa_1315" id="tfa_1315" class="">Zambia</option> <option value="tfa_1316" id="tfa_1316" class="">Zimbabwe</option></select></div> </div> <div id="tfa_1453" class="section inline group"> <div class="oneField field-container-D " id="tfa_1317-D"> <label id="tfa_1317-L" class="label preField " for="tfa_1317">Job Role</label><br><div class="inputWrapper"><select id="tfa_1317" name="tfa_1317" title="Job Role" class=""><option value="">Please select...</option> <option value="tfa_1387" id="tfa_1387" class="">Physician </option> <option value="tfa_1388" id="tfa_1388" class="">Nurse </option> <option value="tfa_1389" id="tfa_1389" class="">Nurse Practitioner </option> <option value="tfa_1390" id="tfa_1390" class="">Physical Therapist </option> <option value="tfa_1391" id="tfa_1391" class="">Physician Assistant </option> <option value="tfa_1392" id="tfa_1392" class="">Occupational Therapist </option> <option value="tfa_1393" id="tfa_1393" class="">Speech-Language </option> <option value="tfa_1398" id="tfa_1398" class="">Pathologist</option> <option value="tfa_1394" id="tfa_1394" class="">Audiologist </option> <option value="tfa_1395" id="tfa_1395" class="">Medical Student </option> <option value="tfa_1396" id="tfa_1396" class="">Researcher </option> <option value="tfa_1397" id="tfa_1397" class="">Other </option></select></div> </div> <div class="htmlSection" id="tfa_1452"><div class="htmlContent" id="tfa_1452-HTML">                                                                                                                                                                                    </div></div> <div class="htmlSection" id="tfa_1455"><div class="htmlContent" id="tfa_1455-HTML">I am interested in receiving the latest innovative research and advances in clinical care in these specialties:</div></div> </div> <div class="oneField field-container-D " id="tfa_1379-D"> <label id="tfa_1379-L" class="label preField " for="tfa_1379">Primary Specialty </label><br><div class="inputWrapper"><select id="tfa_1379" name="tfa_1379" title="Primary Specialty " class=""><option value="">Please select...</option> <option value="tfa_1399" id="tfa_1399" class="">Cancer </option> <option value="tfa_1400" id="tfa_1400" class="">Diabetes & Endocrinology </option> <option value="tfa_1401" id="tfa_1401" class="">Gastroenterology & GI Surgery </option> <option value="tfa_1402" id="tfa_1402" class="">Geriatrics & Palliative Care </option> <option value="tfa_1403" id="tfa_1403" class="">Heart & Vascular </option> <option value="tfa_1404" id="tfa_1404" class="">Neurology & Neurosurgery </option> <option value="tfa_1405" id="tfa_1405" class="">Obstetrics & Gynecology </option> <option value="tfa_1406" id="tfa_1406" class="">Ophthalmology </option> <option value="tfa_1407" id="tfa_1407" class="">Orthopedics </option> <option value="tfa_1408" id="tfa_1408" class="">Otolaryngology </option> <option value="tfa_1409" id="tfa_1409" class="">Physical Medicine & Rehabilitation </option> <option value="tfa_1410" id="tfa_1410" class="">Psychiatry </option> <option value="tfa_1411" id="tfa_1411" class="">Pulmonology </option> <option value="tfa_1412" id="tfa_1412" class="">Radiology </option> <option value="tfa_1413" id="tfa_1413" class="">Rheumatology</option> <option value="tfa_1414" id="tfa_1414" class="">Urology </option></select></div> </div> <div class="oneField field-container-D " id="tfa_1432-D"> <label id="tfa_1432-L" class="label preField " for="tfa_1432">Secondary Specialty </label><br><div class="inputWrapper"><select id="tfa_1432" name="tfa_1432" title="Secondary Specialty " class=""><option value="">Please select...</option> <option value="tfa_1433" id="tfa_1433" class="">Cancer </option> <option value="tfa_1434" id="tfa_1434" class="">Diabetes & Endocrinology </option> <option value="tfa_1435" id="tfa_1435" class="">Gastroenterology & GI Surgery </option> <option value="tfa_1436" id="tfa_1436" class="">Geriatrics & Palliative Care </option> <option value="tfa_1437" id="tfa_1437" class="">Heart & Vascular </option> <option value="tfa_1438" id="tfa_1438" class="">Neurology & Neurosurgery </option> <option value="tfa_1439" id="tfa_1439" class="">Obstetrics & Gynecology </option> <option 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