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display: none; z-index:1000;"> <p><a href="/web/20110627185711/http://physicianrecruit.fairview.org/Jobs/Physicians">Physician Opportunities</a></p> <p><a href="/web/20110627185711/http://physicianrecruit.fairview.org/Jobs/Advanced">Advanced Practice Provider Opportunities</a></p> <p><a href="/web/20110627185711/http://physicianrecruit.fairview.org/Jobs/List_Jobs_By_Specialty">Opportunities By Specialty</a></p> </div> </li> <li> <a href="/web/20110627185711/http://physicianrecruit.fairview.org/Main/OurPartners">Our Partners</a> </li> <li> <a href="/web/20110627185711/http://physicianrecruit.fairview.org/Main/StateofMinnesota">Better Living</a> </li> <li> <a target="_blank" href="https://web.archive.org/web/20110627185711/http://www.fairview.org/Locations/index.htm">Locations</a> </li> <li> <a href="/web/20110627185711/http://physicianrecruit.fairview.org/Main/FAQ">FAQ</a> </li> <li class="selected end"> <a href="/web/20110627185711/http://physicianrecruit.fairview.org/Main/Contact">Contact</a> </li> </ul> </div> <div class="contentArea">  <form action="/web/20110627185711/http://physicianrecruit.fairview.org/Main.mvc/Contact" id="searchFilter" method="post" name="searchFilter" onsubmit="javascript: return validateForm(this,'/Main/ThankYou');"> <input type="hidden" name="returnURL" value=""/> <div class="Main" id="mainContent"> <span style="font-weight:bold;">Account Registration</span> <br/> Thank you for contacting Fairview Health Services Physician Recruitment and Retention. Our department will be in touch with you shortly, in response to your registration. Registering with Fairview Health Services is easy; please fill in the information below to help us identify the best opportunity match for you. <br/><br/> Or, we invite you to <a href="/web/20110627185711/http://physicianrecruit.fairview.org/Jobs">Search and Apply</a> for a specific opportunity. <br/><br/> Thank you! <br/><br/> <div><h3 style="color:Maroon"></h3></div> <div class="formBlock"> <label for="field1" class="column110px">Email<span class="required">*</span></label> <input class="email_required" id="UserName" maxlength="75" name="UserName" type="text" value=""/> <div style="display:none"> <label class="column60px">Home</label> <input checked="checked" class="radio10" id="emailType" name="emailType" type="radio" value="1"/><label class="column60px">Work</label> <input class="radio10" id="emailType" name="emailType" type="radio" value="2"/> </div> </div> <div class="formBlock"> <label class="column275px"><strong>Password must be at least 8 characters long</strong></label> </div> <div class="formBlock"> <label for="field2" class="column110px">Password<span class="required">*</span></label> <input class="text_required" id="password" maxlength="25" name="password" onkeydown="setTimeout(function() { strength_check(); }, 50);" type="password" value=""/> <label for="field3" class="column110px">Confirm Password<span class="required">*</span></label> <input class="text_required" id="passwordConfirmation" maxlength="25" name="passwordConfirmation" onkeydown="setTimeout(function() { strength_check(); }, 50);" type="password" value=""/> </div> <div class="formBlock" style="display:none;"> <div id="Div1" style="padding:2px; width:120px; text-align:right;"> <div id="strength_text" style="font-size: small; background-color:White;"></div> </div> <div id="Div17" style="padding:2px;"> <div id="strength_bar" style="background-image:url(/web/20110627185711im_/http://physicianrecruit.fairview.org/Content/Fairview/Images/password_strength.png);height:20px; width:0px; background-repeat:no-repeat;"></div> </div> </div> <div class="formBlock"> <label for="field4" class="column110px">Security Question<span class="required">*</span></label> <select class="dropdown_required" id="securityQuestion" name="SecurityQuestionId"><option value="1">What was your childhood nickname?</option> <option value="2">In what city did you meet your spouse/significant other?</option> <option value="3">What is the name of your favorite childhood friend?</option> <option value="4">What street did you live on in third grade?</option> <option value="5">What school did you attend in Sixth grade?</option> <option value="6">What was the name of your first stuffed animal?</option> <option value="7">In what city or town did your mother and father meet?</option> <option value="8">What is your mother's maiden name?</option> </select> <label for="field5" class="column110px">Answer<span class="required">*</span></label> <input class="text_required" id="SecurityAnswer" maxlength="29" name="SecurityAnswer" type="text" value=""/> </div> <div class="formBlock"> <label for="field6" class="column110px">First<span class="required">*</span></label> <input class="text_required" id="Person_FirstName" maxlength="100" name="Person.FirstName" type="text" value=""/> <label for="field7" class="column70px">Middle</label> <input class="text" id="Person_MiddleName" maxlength="100" name="Person.MiddleName" type="text" value=""/> <label for="field8" class="column60px">Last<span class="required">*</span></label> <input class="text_required" id="Person_LastName" maxlength="100" name="Person.LastName" type="text" value=""/> </div> <div class="formBlock"> <label for="field14" class="column110px">Primary Specialty<span class="required">*</span></label> <select class="dropdown_required" id="primarySpecialty" name="Person.Doctor.PrimarySpecialty.SpecialtyId"><option value="">Choose ..</option> <option value="262">Academic, Medical School Dean</option> <option value="263">Academic, Medical School Professor</option> <option value="264">Academic, Program Director</option> <option value="401">Acute Care</option> <option value="361">Addiction Medicine</option> <option value="83">Adolescent Medicine</option> <option value="84">Aerospace Medicine</option> <option value="1">Allergy and Immunology</option> <option value="2">Ambulatory Medicine</option> <option value="423">Anesthesiology Assistant (AA)</option> <option value="4">Anesthesiology, Cardiac</option> <option value="398">Anesthesiology, Critical Care</option> <option value="3">Anesthesiology, General</option> <option value="276">Anesthesiology, Neuro</option> <option value="5">Anesthesiology, Pain Management</option> <option value="304">Audiology</option> <option value="320">Bariatrics, General</option> <option value="297">Biochemical Genetics</option> <option value="228">Bone and Mineral Metabolism</option> <option value="392">Cardiac Imaging</option> <option value="342">Cardio-Thoracic / Vascular</option> <option value="391">Cardiology Echo</option> <option value="8">Cardiology, Electrophysiologist</option> <option value="237">Cardiology, General</option> <option value="194">Cardiology, Heart Failure / Heart Transplant</option> <option value="101">Cardiology, Interventional</option> <option value="6">Cardiology, Invasive</option> <option value="390">Cardiology, Invasive, Non-Interventional</option> <option value="335">Cardiology, Non-Interventional</option> <option value="7">Cardiology, Non-Invasive</option> <option value="161">Cardiology, Nuclear</option> <option value="208">Cardiology, Peripheral Vascular</option> <option value="265">Cardiopulmonary</option> <option value="170">Cardiovascular Disease</option> <option value="76">Certified Nurse Midwife</option> <option value="75">Certified Registered Nurse Anesthetist</option> <option value="284">Chiropractor</option> <option value="362">Clinical Cytogenetics</option> <option value="332">Correctional Medicine</option> <option value="343">Critical Care</option> <option value="88">Critical Care Medicine, AN</option> <option value="89">Critical Care Medicine, IM</option> <option value="10">Dentistry</option> <option value="219">Dentistry, Pediatric</option> <option value="220">Dentistry, Periodontics</option> <option value="298">Dentistry, Surgery: General</option> <option value="11">Dermatology, General</option> <option value="408">Dermatology, Immunology</option> <option value="280">Dermatology, MOHS / Procedural</option> <option value="348">Diabetes</option> <option value="12">Emergency Medicine</option> <option value="290">Emergency Medicine, Utrasoundography</option> <option value="187">Endocrinology, Diabetes and Metabolism</option> <option value="52">Endocrinology, Reproductive</option> <option value="175">Endovascular</option> <option value="344">ENT</option> <option value="37">ENT / Otolaryngology</option> <option value="406">ENT / Otolaryngology, Rhinology</option> <option value="331">Epidemiologist</option> <option value="274">Ethicist</option> <option value="349">Executive Medicine</option> <option value="259">Executive Mgmt (Non-Clinical), Chief Executive Officer</option> <option value="261">Executive Mgmt (Non-Clinical), Chief Financial Officer</option> <option value="260">Executive Mgmt (Non-Clinical), Chief Operations Officer</option> <option value="199">Family Medicine, Academic</option> <option value="299">Family Medicine, Emergency Medicine</option> <option value="326">Family Medicine, General</option> <option value="300">Family Medicine, Geriatrics</option> <option value="201">Family Medicine, Hospitalist</option> <option value="203">Family Medicine, Internal Medicine</option> <option value="293">Family Medicine, Nocturnist</option> <option value="195">Family Medicine, OB Optional</option> <option value="363">Family Medicine, Urgent Care</option> <option value="14">Family Medicine, with OB</option> <option value="15">Family Medicine, without OB</option> <option value="204">Flight Medicine</option> <option value="202">FM / IM, Hospitalist</option> <option value="16">Gastroenterology</option> <option value="236">Gastroenterology and Hepatology</option> <option value="339">Gastroenterology, Interventional</option> <option value="17">General Medicine</option> <option value="93">General Preventive Medicine</option> <option value="275">Geneticist</option> <option value="350">Geriatric Medicine</option> <option value="94">Geriatric Medicine, FM</option> <option value="95">Geriatric Medicine, IM</option> <option value="19">Gynecological Oncology</option> <option value="178">Gynecological Urology</option> <option value="20">Gynecology</option> <option value="144">Hematology</option> <option value="21">Hematology / Oncology</option> <option value="98">Hematopathology</option> <option value="232">Hepatology</option> <option value="327">Hepatology, Transplant</option> <option value="364">Holistic Medicine</option> <option value="365">Hospice and Palliative Medicine</option> <option value="345">Hospitalist</option> <option value="396">Hospitalist, Pediatric</option> <option value="100">Hyperbaric Medicine</option> <option value="164">Immunology, General</option> <option value="22">Infectious Disease</option> <option value="321">Integrative Medicine</option> <option value="385">Intensivist, Cardiology</option> <option value="323">Intensivist, Critical Care</option> <option value="257">Intensivist, General</option> <option value="271">Intensivist, Neurosurgical</option> <option value="386">Intensivist, Pediatric</option> <option value="278">Internal Medicine, Addiction Medicine</option> <option value="269">Internal Medicine, Adult Health</option> <option value="329">Internal Medicine, Behavioral</option> <option value="366">Internal Medicine, Cardiology</option> <option value="250">Internal Medicine, Critical Care: Trauma</option> <option value="367">Internal Medicine, Dermatology</option> <option value="186">Internal Medicine, Diabetes</option> <option value="303">Internal Medicine, Emergency Medicine</option> <option value="328">Internal Medicine, Endocrinology</option> <option value="23">Internal Medicine, General</option> <option value="305">Internal Medicine, Hematology / Oncology</option> <option value="301">Internal Medicine, Hematology / Oncology, Bone Marrow Transplantation</option> <option value="188">Internal Medicine, Hepatology</option> <option value="99">Internal Medicine, Hospitalist</option> <option value="354">Internal Medicine, House Officer</option> <option value="306">Internal Medicine, Infectious Disease</option> <option value="307">Internal Medicine, Nephrology</option> <option value="368">Internal Medicine, Neurology</option> <option value="292">Internal Medicine, Nocturnist</option> <option value="308">Internal Medicine, Occupational Medicine</option> <option value="190">Internal Medicine, Pain Management</option> <option value="191">Internal Medicine, Palliative</option> <option value="314">Internal Medicine, Pediatric: General</option> <option value="312">Internal Medicine, Pediatric: Hospitalist</option> <option value="313">Internal Medicine, Pediatric: Pulmonology / Sleep</option> <option value="229">Internal Medicine, Preventive Medicine</option> <option value="309">Internal Medicine, Pulmonology</option> <option value="310">Internal Medicine, Rheumatology</option> <option value="288">Internal Medicine, Sleep Medicine</option> <option value="311">Internal Medicine, Urgent Care</option> <option value="192">Internal Medicine, Vascular</option> <option value="407">Laryngology</option> <option value="189">Legal Medicine</option> <option value="346">Mammography</option> <option value="24">Maternal Fetal Medicine</option> <option value="25">Med / Peds</option> <option value="295">Medical Administration, Chief Medical Information Officer</option> <option value="294">Medical Administration, Chief Medical Officer</option> <option value="63">Medical Administration, General</option> <option value="369">Medical Administration, General Medical Officer</option> <option value="397">Medical Administration, Health Plans</option> <option value="165">Medical Administration, Medical Director</option> <option value="296">Medical Administration, Pediatric</option> <option value="70">Medical Administration, Program Director</option> <option value="193">Medical Administration, Research Director</option> <option value="291">Medical Bariatrics</option> <option value="166">Medical Genetics</option> <option value="148">Medical Oncology</option> <option value="26">Neonatal - Perinatal Medicine</option> <option value="27">Nephrology</option> <option value="268">Nephrology, Transplant</option> <option value="227">Neuro-Oncology</option> <option value="162">Neuroimmunology</option> <option value="79">Neurology</option> <option value="424">Neurology, Child</option> <option value="286">Neurology, Critical Care</option> <option value="340">Neurology, EEG</option> <option value="281">Neurology, Electromyography</option> <option value="283">Neurology, Neurophysiology: Epilepsy</option> <option value="333">Neurology, Pain Management</option> <option value="196">Neurology, Sleep Medicine</option> <option value="334">Neurology, Spine</option> <option value="285">Neurology, Stroke</option> <option value="405">Neurology, Urology</option> <option value="205">Neuromusculoskeletal & Osteopathic Manipulative Medicine</option> <option value="150">Neurophysiology</option> <option value="351">Neuropsychology</option> <option value="105">Neuroradiology</option> <option value="210">NeuroUrology and Urodynamic</option> <option value="160">Nuclear Immunology</option> <option value="28">Nuclear Medicine</option> <option value="246">Nurse Practitioner, Acute Care</option> <option value="243">Nurse Practitioner, Adult</option> <option value="337">Nurse Practitioner, ED</option> <option value="244">Nurse Practitioner, Family</option> <option value="74">Nurse Practitioner, General</option> <option value="241">Nurse Practitioner, Gerontologica</option> <option value="273">Nurse Practitioner, Hematology / Oncology</option> <option value="535">Nurse Practitioner, Hospitalist</option> <option value="248">Nurse Practitioner, Mental Health: Adult Psych</option> <option value="249">Nurse Practitioner, Mental Health: Family Psych</option> <option value="247">Nurse Practitioner, Mental Health: General</option> <option value="240">Nurse Practitioner, Neonatal</option> <option value="356">Nurse Practitioner, OB/GYN</option> <option value="279">Nurse Practitioner, Palliative Care</option> <option value="242">Nurse Practitioner, Pediatric</option> <option value="341">Nurse Practitioner, Primary Care</option> <option value="245">Nurse Practitioner, Women's Health</option> <option value="168">Nutrition</option> <option value="31">Obstetrics and Gynecology</option> <option value="32">Occupational Medicine</option> <option value="33">Oncology, General</option> <option value="370">Oncology, GYN</option> <option value="102">Oncology, Musculoskeletal</option> <option value="223">Oncology, Orthopedic</option> <option value="267">Oncology, Urologic</option> <option value="151">Ophthalmology, Corneal Disease</option> <option value="34">Ophthalmology, General</option> <option value="266">Ophthalmology, General Surgery</option> <option value="152">Ophthalmology, Glaucoma</option> <option value="221">Ophthalmology, Neuro</option> <option value="155">Ophthalmology, Refractive Surgery</option> <option value="36">Ophthalmology, Retinal: General</option> <option value="106">Ophthalmology, Retinal: Surgery</option> <option value="141">Optometrist</option> <option value="256">Orthopaedics</option> <option value="404">Otology, General</option> <option value="215">Otology, Neurotology</option> <option value="224">Otorhinolaryngology</option> <option value="371">Pain Management</option> <option value="238">Palliative Medicine</option> <option value="38">Pathology, Anatomic</option> <option value="136">Pathology, Anatomic and Clinical</option> <option value="137">Pathology, Cardiovascular</option> <option value="372">Pathology, Chemical Pathology/Informatics</option> <option value="39">Pathology, Clinical / Laboratory Medicine</option> <option value="90">Pathology, Cytology</option> <option value="91">Pathology, Dermatology</option> <option value="393">Pathology, Dermatopathology</option> <option value="9">Pathology, Forensic</option> <option value="347">Pathology, General</option> <option value="104">Pathology, Neurology</option> <option value="138">Pathology, Pediatrics</option> <option value="147">Pathology, Surgical</option> <option value="394">Pediatric, Adolescent Medicine</option> <option value="207">Pediatric, Allergy and Immunology</option> <option value="109">Pediatric, Anesthesiology</option> <option value="373">Pediatric, Behavioral</option> <option value="110">Pediatric, Cardiology</option> <option value="289">Pediatric, Child Abuse</option> <option value="374">Pediatric, Critical Care</option> <option value="40">Pediatric, Critical Care / Intensivist</option> <option value="233">Pediatric, Dermatology</option> <option value="251">Pediatric, Developmental</option> <option value="111">Pediatric, Emergency Medicine (EM)</option> <option value="112">Pediatric, Emergency Medicine (PEM)</option> <option value="113">Pediatric, Endocrinology</option> <option value="399">Pediatric, Family Medicine</option> <option value="41">Pediatric, Gastroenterology</option> <option value="44">Pediatric, General</option> <option value="42">Pediatric, Hematology / Oncology</option> <option value="176">Pediatric, Hospitalist</option> <option value="114">Pediatric, Infectious Disease</option> <option value="115">Pediatric, Medical Genetics</option> <option value="200">Pediatric, Neonatology</option> <option value="116">Pediatric, Nephrology</option> <option value="213">Pediatric, Neurodevelopmental</option> <option value="43">Pediatric, Neurology</option> <option value="35">Pediatric, Opthalmology</option> <option value="325">Pediatric, Orthopedics</option> <option value="117">Pediatric, Otolaryngology</option> <option value="118">Pediatric, Physical Medicine and Rehab</option> <option value="78">Pediatric, Pulmonology</option> <option value="322">Pediatric, Pulmonology: Sleep Medicine</option> <option value="316">Pediatric, Radiation Oncology</option> <option value="120">Pediatric, Rheumatology</option> <option value="302">Pediatric, Sleep Medicine</option> <option value="121">Pediatric, Sports Medicine</option> <option value="235">Pediatric, Urgent Care</option> <option value="122">Pediatric, Urology</option> <option value="258">Pharmacology, Clinical</option> <option value="421">Physchiatry, Psychopharmacology</option> <option value="420">Physchiatry, Psychosomatic</option> <option value="184">Physiatry</option> <option value="182">Physiatry, Interventional</option> <option value="45">Physical Medicine and Rehab</option> <option value="183">Physical Medicine and Rehab, Pain Management</option> <option value="139">Physician Assistant</option> <option value="403">Physician Assistant, Cardio</option> <option value="336">Physician Assistant, ED</option> <option value="338">Physician Assistant, Hospitalist</option> <option value="402">Physician Assistant, Orthopedics</option> <option value="270">Physician Assistant, Pain Management</option> <option value="324">Physicist</option> <option value="153">Physiology</option> <option value="46">Podiatry</option> <option value="154">Preventive Medicine</option> <option value="82">Psychiatry, Addiction</option> <option value="167">Psychiatry, Adult</option> <option value="85">Psychiatry, Child and Adolescent</option> <option value="123">Psychiatry, Family Medicine</option> <option value="92">Psychiatry, Forensic</option> <option value="47">Psychiatry, General</option> <option value="252">Psychiatry, Geriatric</option> <option value="375">Psychiatry, Internal Medicine</option> <option value="124">Psychiatry, Neurology</option> <option value="422">Psychiatry, Research</option> <option value="157">Psychiatry, Sleep Disorder</option> <option value="140">Psychologist</option> <option value="409">Psychosomatic Medicine</option> <option value="125">Public Health</option> <option value="127">Pulmonary Disease, Critical Care</option> <option value="206">Pulmonary Disease, Critical Care / Sleep</option> <option value="126">Pulmonary Disease, General</option> <option value="77">Pulmonary Disease, Sleep</option> <option value="48">Pulmonology</option> <option value="49">Radiation Oncology</option> <option value="277">Radiation, General</option> <option value="81">Radiology, Abdominal</option> <option value="253">Radiology, Body Imaging</option> <option value="317">Radiology, Breast Imaging</option> <option value="389">Radiology, Cardiac Imaging</option> <option value="387">Radiology, Cardiac Imaging</option> <option value="413">Radiology, Cardiothoracic Imaging</option> <option value="412">Radiology, Cardiovascular</option> <option value="414">Radiology, Chest</option> <option value="415">Radiology, Cross Sectional</option> <option value="174">Radiology, CT</option> <option value="287">Radiology, Diag: General</option> <option value="50">Radiology, Diag: Inv/Intervent</option> <option value="51">Radiology, Diag: Noninvasive</option> <option value="416">Radiology, Emergency</option> <option value="352">Radiology, General</option> <option value="318">Radiology, Interventional</option> <option value="171">Radiology, Mammography</option> <option value="149">Radiology, MRI</option> <option value="319">Radiology, MSK Imaging</option> <option value="103">Radiology, Musculoskeletal</option> <option value="400">Radiology, Neuro</option> <option value="145">Radiology, Neuro - Diagnostic</option> <option value="355">Radiology, Neuro-Interventional</option> <option value="30">Radiology, Nuclear</option> <option value="119">Radiology, Pediatric</option> <option value="417">Radiology, Thoracic</option> <option value="418">Radiology, Trauma</option> <option value="376">Radiology, Ultrasound</option> <option value="419">Radiology, Vascular/Interventional </option> <option value="360">Radiology, Women's Imager</option> <option value="377">Reproductive Endocrinology and Fertility</option> <option value="179">Research</option> <option value="53">Rheumatology</option> <option value="378">Sleep Medicine</option> <option value="128">Spinal Cord Injury Medicine</option> <option value="129">Sports Medicine, EM</option> <option value="130">Sports Medicine, FM</option> <option value="54">Sports Medicine, General</option> <option value="131">Sports Medicine, IM</option> <option value="107">Sports Medicine, Orthopedic</option> <option value="379">Sports Medicine, Rehab</option> <option value="158">Surgery, Bariatrics</option> <option value="185">Surgery, Breast</option> <option value="209">Surgery, Breast: Oncology</option> <option value="86">Surgery, Burn</option> <option value="169">Surgery, Cardiothoracic</option> <option value="358">Surgery, Cardiothoracic: Thoraco-Abdominal</option> <option value="359">Surgery, Cardiothoracic:Advanced Aortic</option> <option value="59">Surgery, Cardiovascular</option> <option value="226">Surgery, Cardiovascular & Thoracic</option> <option value="60">Surgery, Colon and Rectal</option> <option value="87">Surgery, Craniofacial</option> <option value="142">Surgery, Critical Care</option> <option value="380">Surgery, Dental</option> <option value="217">Surgery, Dermatologic</option> <option value="239">Surgery, Endo</option> <option value="216">Surgery, Endocrine and Oncological</option> <option value="143">Surgery, Facial Plastic</option> <option value="80">Surgery, GastroIntestinal/Colorectal</option> <option value="61">Surgery, General</option> <option value="18">Surgery, General: Hand</option> <option value="163">Surgery, Head & Neck</option> <option value="214">Surgery, Invasive</option> <option value="181">Surgery, Laparoscopic</option> <option value="255">Surgery, Laser</option> <option value="62">Surgery, Maxillofacial</option> <option value="395">Surgery, Minimally Invasive</option> <option value="29">Surgery, Neurosurgical</option> <option value="272">Surgery, Neurosurgical: Vascular</option> <option value="381">Surgery, OB / GYN</option> <option value="254">Surgery, Oculoplastic</option> <option value="132">Surgery, Oncology</option> <option value="382">Surgery, Ophthalmology</option> <option value="71">Surgery, Oral</option> <option value="222">Surgery, Oral and Maxillofacial</option> <option value="56">Surgery, Ortho: Foot and Ankle</option> <option value="64">Surgery, Ortho: General</option> <option value="96">Surgery, Ortho: Hand</option> <option value="231">Surgery, Ortho: Hip and Knee</option> <option value="57">Surgery, Ortho: Joint replacement</option> <option value="146">Surgery, Ortho: Muscular</option> <option value="353">Surgery, Ortho: Neuro</option> <option value="172">Surgery, Ortho: Pediatric</option> <option value="230">Surgery, Ortho: Shoulder and Elbow</option> <option value="58">Surgery, Ortho: Spine</option> <option value="173">Surgery, Ortho: Sports</option> <option value="108">Surgery, Ortho: Trauma</option> <option value="383">Surgery, Otorhinolaryngology</option> <option value="72">Surgery, Pediatric</option> <option value="55">Surgery, Pediatric Cardiovascular</option> <option value="180">Surgery, Pediatric: Cardiothoracic</option> <option value="225">Surgery, Pediatric: Neurosurgical</option> <option value="315">Surgery, Pediatric: Plastic</option> <option value="68">Surgery, Peripheral Vascular</option> <option value="65">Surgery, Plastic</option> <option value="218">Surgery, Plastic: Cosmetic</option> <option value="198">Surgery, Plastic: Facial</option> <option value="97">Surgery, Plastic: Hand</option> <option value="357">Surgery, Plastic: Microvascular</option> <option value="234">Surgery, Plastic: Reconstructive</option> <option value="159">Surgery, Reconstructive</option> <option value="156">Surgery, Renal Transplant</option> <option value="410">Surgery, Skull</option> <option value="66">Surgery, Thoracic</option> <option value="67">Surgery, Thoracic and Vascular</option> <option value="197">Surgery, Transplant</option> <option value="388">Surgery, Transplant: Bone Marrow</option> <option value="133">Surgery, Trauma</option> <option value="212">Surgery, Urology</option> <option value="69">Surgery, Vascular</option> <option value="211">Surgery, Vitreoretinal</option> <option value="411">Toxicology, General</option> <option value="134">Urgent Care</option> <option value="384">Urgent Care, Occupational Health</option> <option value="330">Urogynecology</option> <option value="177">Urology, Endo</option> <option value="73">Urology, General</option> <option value="135">Womens Health</option> <option value="282">Wound Care</option> </select> </div> <div class="formBlock"> <label for="field16" class="column110px">Secondary Specialty</label> <select class="dropAuto" id="Person_Doctor_SecondarySpecialty_SpecialtyId" name="Person.Doctor.SecondarySpecialty.SpecialtyId"><option value="">Choose ..</option> <option value="262">Academic, Medical School Dean</option> <option value="263">Academic, Medical School Professor</option> <option value="264">Academic, Program Director</option> <option value="401">Acute Care</option> <option value="361">Addiction Medicine</option> <option value="83">Adolescent Medicine</option> <option value="84">Aerospace Medicine</option> <option value="1">Allergy and Immunology</option> <option value="2">Ambulatory Medicine</option> <option value="423">Anesthesiology Assistant (AA)</option> <option value="4">Anesthesiology, Cardiac</option> <option value="398">Anesthesiology, Critical Care</option> <option value="3">Anesthesiology, General</option> <option value="276">Anesthesiology, Neuro</option> <option value="5">Anesthesiology, Pain Management</option> <option value="304">Audiology</option> <option value="320">Bariatrics, General</option> <option value="297">Biochemical Genetics</option> <option value="228">Bone and Mineral Metabolism</option> <option value="392">Cardiac Imaging</option> <option value="342">Cardio-Thoracic / Vascular</option> <option value="391">Cardiology Echo</option> <option value="8">Cardiology, Electrophysiologist</option> <option value="237">Cardiology, General</option> <option value="194">Cardiology, Heart Failure / Heart Transplant</option> <option value="101">Cardiology, Interventional</option> <option value="6">Cardiology, Invasive</option> <option value="390">Cardiology, Invasive, Non-Interventional</option> <option value="335">Cardiology, Non-Interventional</option> <option value="7">Cardiology, Non-Invasive</option> <option value="161">Cardiology, Nuclear</option> <option value="208">Cardiology, Peripheral Vascular</option> <option value="265">Cardiopulmonary</option> <option value="170">Cardiovascular Disease</option> <option value="76">Certified Nurse Midwife</option> <option value="75">Certified Registered Nurse Anesthetist</option> <option value="284">Chiropractor</option> <option value="362">Clinical Cytogenetics</option> <option value="332">Correctional Medicine</option> <option value="343">Critical Care</option> <option value="88">Critical Care Medicine, AN</option> <option value="89">Critical Care Medicine, IM</option> <option value="10">Dentistry</option> <option value="219">Dentistry, Pediatric</option> <option value="220">Dentistry, Periodontics</option> <option value="298">Dentistry, Surgery: General</option> <option value="11">Dermatology, General</option> <option value="408">Dermatology, Immunology</option> <option value="280">Dermatology, MOHS / Procedural</option> <option value="348">Diabetes</option> <option value="12">Emergency Medicine</option> <option value="290">Emergency Medicine, Utrasoundography</option> <option value="187">Endocrinology, Diabetes and Metabolism</option> <option value="52">Endocrinology, Reproductive</option> <option value="175">Endovascular</option> <option value="344">ENT</option> <option value="37">ENT / Otolaryngology</option> <option value="406">ENT / Otolaryngology, Rhinology</option> <option value="331">Epidemiologist</option> <option value="274">Ethicist</option> <option value="349">Executive Medicine</option> <option value="259">Executive Mgmt (Non-Clinical), Chief Executive Officer</option> <option value="261">Executive Mgmt (Non-Clinical), Chief Financial Officer</option> <option value="260">Executive Mgmt (Non-Clinical), Chief Operations Officer</option> <option value="199">Family Medicine, Academic</option> <option value="299">Family Medicine, Emergency Medicine</option> <option value="326">Family Medicine, General</option> <option value="300">Family Medicine, Geriatrics</option> <option value="201">Family Medicine, Hospitalist</option> <option value="203">Family Medicine, Internal Medicine</option> <option value="293">Family Medicine, Nocturnist</option> <option value="195">Family Medicine, OB Optional</option> <option value="363">Family Medicine, Urgent Care</option> <option value="14">Family Medicine, with OB</option> <option value="15">Family Medicine, without OB</option> <option value="204">Flight Medicine</option> <option value="202">FM / IM, Hospitalist</option> <option value="16">Gastroenterology</option> <option value="236">Gastroenterology and Hepatology</option> <option value="339">Gastroenterology, Interventional</option> <option value="17">General Medicine</option> <option value="93">General Preventive Medicine</option> <option value="275">Geneticist</option> <option value="350">Geriatric Medicine</option> <option value="94">Geriatric Medicine, FM</option> <option value="95">Geriatric Medicine, IM</option> <option value="19">Gynecological Oncology</option> <option value="178">Gynecological Urology</option> <option value="20">Gynecology</option> <option value="144">Hematology</option> <option value="21">Hematology / Oncology</option> <option value="98">Hematopathology</option> <option value="232">Hepatology</option> <option value="327">Hepatology, Transplant</option> <option value="364">Holistic Medicine</option> <option value="365">Hospice and Palliative Medicine</option> <option value="345">Hospitalist</option> <option value="396">Hospitalist, Pediatric</option> <option value="100">Hyperbaric Medicine</option> <option value="164">Immunology, General</option> <option value="22">Infectious Disease</option> <option value="321">Integrative Medicine</option> <option value="385">Intensivist, Cardiology</option> <option value="323">Intensivist, Critical Care</option> <option value="257">Intensivist, General</option> <option value="271">Intensivist, Neurosurgical</option> <option value="386">Intensivist, Pediatric</option> <option value="278">Internal Medicine, Addiction Medicine</option> <option value="269">Internal Medicine, Adult Health</option> <option value="329">Internal Medicine, Behavioral</option> <option value="366">Internal Medicine, Cardiology</option> <option value="250">Internal Medicine, Critical Care: Trauma</option> <option value="367">Internal Medicine, Dermatology</option> <option value="186">Internal Medicine, Diabetes</option> <option value="303">Internal Medicine, Emergency Medicine</option> <option value="328">Internal Medicine, Endocrinology</option> <option value="23">Internal Medicine, General</option> <option value="305">Internal Medicine, Hematology / Oncology</option> <option value="301">Internal Medicine, Hematology / Oncology, Bone Marrow Transplantation</option> <option value="188">Internal Medicine, Hepatology</option> <option value="99">Internal Medicine, Hospitalist</option> <option value="354">Internal Medicine, House Officer</option> <option value="306">Internal Medicine, Infectious Disease</option> <option value="307">Internal Medicine, Nephrology</option> <option value="368">Internal Medicine, Neurology</option> <option value="292">Internal Medicine, Nocturnist</option> <option value="308">Internal Medicine, Occupational Medicine</option> <option value="190">Internal Medicine, Pain Management</option> <option value="191">Internal Medicine, Palliative</option> <option value="314">Internal Medicine, Pediatric: General</option> <option value="312">Internal Medicine, Pediatric: Hospitalist</option> <option value="313">Internal Medicine, Pediatric: Pulmonology / Sleep</option> <option value="229">Internal Medicine, Preventive Medicine</option> <option value="309">Internal Medicine, Pulmonology</option> <option value="310">Internal Medicine, Rheumatology</option> <option value="288">Internal Medicine, Sleep Medicine</option> <option value="311">Internal Medicine, Urgent Care</option> <option value="192">Internal Medicine, Vascular</option> <option value="407">Laryngology</option> <option value="189">Legal Medicine</option> <option value="346">Mammography</option> <option value="24">Maternal Fetal Medicine</option> <option value="25">Med / Peds</option> <option value="295">Medical Administration, Chief Medical Information Officer</option> <option value="294">Medical Administration, Chief Medical Officer</option> <option value="63">Medical Administration, General</option> <option value="369">Medical Administration, General Medical Officer</option> <option value="397">Medical Administration, Health Plans</option> <option value="165">Medical Administration, Medical Director</option> <option value="296">Medical Administration, Pediatric</option> <option value="70">Medical Administration, Program Director</option> <option value="193">Medical Administration, Research Director</option> <option value="291">Medical Bariatrics</option> <option value="166">Medical Genetics</option> <option value="148">Medical Oncology</option> <option value="26">Neonatal - Perinatal Medicine</option> <option value="27">Nephrology</option> <option value="268">Nephrology, Transplant</option> <option value="227">Neuro-Oncology</option> <option value="162">Neuroimmunology</option> <option value="79">Neurology</option> <option value="424">Neurology, Child</option> <option value="286">Neurology, Critical Care</option> <option value="340">Neurology, EEG</option> <option value="281">Neurology, Electromyography</option> <option value="283">Neurology, Neurophysiology: Epilepsy</option> <option value="333">Neurology, Pain Management</option> <option value="196">Neurology, Sleep Medicine</option> <option value="334">Neurology, Spine</option> <option value="285">Neurology, Stroke</option> <option value="405">Neurology, Urology</option> <option value="205">Neuromusculoskeletal & Osteopathic Manipulative Medicine</option> <option value="150">Neurophysiology</option> <option value="351">Neuropsychology</option> <option value="105">Neuroradiology</option> <option value="210">NeuroUrology and Urodynamic</option> <option value="160">Nuclear Immunology</option> <option value="28">Nuclear Medicine</option> <option value="246">Nurse Practitioner, Acute Care</option> <option value="243">Nurse Practitioner, Adult</option> <option value="337">Nurse Practitioner, ED</option> <option value="244">Nurse Practitioner, Family</option> <option value="74">Nurse Practitioner, General</option> <option value="241">Nurse Practitioner, Gerontologica</option> <option value="273">Nurse Practitioner, Hematology / Oncology</option> <option value="535">Nurse Practitioner, Hospitalist</option> <option value="248">Nurse Practitioner, Mental Health: Adult Psych</option> <option value="249">Nurse Practitioner, Mental Health: Family Psych</option> <option value="247">Nurse Practitioner, Mental Health: General</option> <option value="240">Nurse Practitioner, Neonatal</option> <option value="356">Nurse Practitioner, OB/GYN</option> <option value="279">Nurse Practitioner, Palliative Care</option> <option value="242">Nurse Practitioner, Pediatric</option> <option value="341">Nurse Practitioner, Primary Care</option> <option value="245">Nurse Practitioner, Women's Health</option> <option value="168">Nutrition</option> <option value="31">Obstetrics and Gynecology</option> <option value="32">Occupational Medicine</option> <option value="33">Oncology, General</option> <option value="370">Oncology, GYN</option> <option value="102">Oncology, Musculoskeletal</option> <option value="223">Oncology, Orthopedic</option> <option value="267">Oncology, Urologic</option> <option value="151">Ophthalmology, Corneal Disease</option> <option value="34">Ophthalmology, General</option> <option value="266">Ophthalmology, General Surgery</option> <option value="152">Ophthalmology, Glaucoma</option> <option value="221">Ophthalmology, Neuro</option> <option value="155">Ophthalmology, Refractive Surgery</option> <option value="36">Ophthalmology, Retinal: General</option> <option value="106">Ophthalmology, Retinal: Surgery</option> <option value="141">Optometrist</option> <option value="256">Orthopaedics</option> <option value="404">Otology, General</option> <option value="215">Otology, Neurotology</option> <option value="224">Otorhinolaryngology</option> <option value="371">Pain Management</option> <option value="238">Palliative Medicine</option> <option value="38">Pathology, Anatomic</option> <option value="136">Pathology, Anatomic and Clinical</option> <option value="137">Pathology, Cardiovascular</option> <option value="372">Pathology, Chemical Pathology/Informatics</option> <option value="39">Pathology, Clinical / Laboratory Medicine</option> <option value="90">Pathology, Cytology</option> <option value="91">Pathology, Dermatology</option> <option value="393">Pathology, Dermatopathology</option> <option value="9">Pathology, Forensic</option> <option value="347">Pathology, General</option> <option value="104">Pathology, Neurology</option> <option value="138">Pathology, Pediatrics</option> <option value="147">Pathology, Surgical</option> <option value="394">Pediatric, Adolescent Medicine</option> <option value="207">Pediatric, Allergy and Immunology</option> <option value="109">Pediatric, Anesthesiology</option> <option value="373">Pediatric, Behavioral</option> <option value="110">Pediatric, Cardiology</option> <option value="289">Pediatric, Child Abuse</option> <option value="374">Pediatric, Critical Care</option> <option value="40">Pediatric, Critical Care / Intensivist</option> <option value="233">Pediatric, Dermatology</option> <option value="251">Pediatric, Developmental</option> <option value="111">Pediatric, Emergency Medicine (EM)</option> <option value="112">Pediatric, Emergency Medicine (PEM)</option> <option value="113">Pediatric, Endocrinology</option> <option value="399">Pediatric, Family Medicine</option> <option value="41">Pediatric, Gastroenterology</option> <option value="44">Pediatric, General</option> <option value="42">Pediatric, Hematology / Oncology</option> <option value="176">Pediatric, Hospitalist</option> <option value="114">Pediatric, Infectious Disease</option> <option value="115">Pediatric, Medical Genetics</option> <option value="200">Pediatric, Neonatology</option> <option value="116">Pediatric, Nephrology</option> <option value="213">Pediatric, Neurodevelopmental</option> <option value="43">Pediatric, Neurology</option> <option value="35">Pediatric, Opthalmology</option> <option value="325">Pediatric, Orthopedics</option> <option value="117">Pediatric, Otolaryngology</option> <option value="118">Pediatric, Physical Medicine and Rehab</option> <option value="78">Pediatric, Pulmonology</option> <option value="322">Pediatric, Pulmonology: Sleep Medicine</option> <option value="316">Pediatric, Radiation Oncology</option> <option value="120">Pediatric, Rheumatology</option> <option value="302">Pediatric, Sleep Medicine</option> <option value="121">Pediatric, Sports Medicine</option> <option value="235">Pediatric, Urgent Care</option> <option value="122">Pediatric, Urology</option> <option value="258">Pharmacology, Clinical</option> <option value="421">Physchiatry, Psychopharmacology</option> <option value="420">Physchiatry, Psychosomatic</option> <option value="184">Physiatry</option> <option value="182">Physiatry, Interventional</option> <option value="45">Physical Medicine and Rehab</option> <option value="183">Physical Medicine and Rehab, Pain Management</option> <option value="139">Physician Assistant</option> <option value="403">Physician Assistant, Cardio</option> <option value="336">Physician Assistant, ED</option> <option value="338">Physician Assistant, Hospitalist</option> <option value="402">Physician Assistant, Orthopedics</option> <option value="270">Physician Assistant, Pain Management</option> <option value="324">Physicist</option> <option value="153">Physiology</option> <option value="46">Podiatry</option> <option value="154">Preventive Medicine</option> <option value="82">Psychiatry, Addiction</option> <option value="167">Psychiatry, Adult</option> <option value="85">Psychiatry, Child and Adolescent</option> <option value="123">Psychiatry, Family Medicine</option> <option value="92">Psychiatry, Forensic</option> <option value="47">Psychiatry, General</option> <option value="252">Psychiatry, Geriatric</option> <option value="375">Psychiatry, Internal Medicine</option> <option value="124">Psychiatry, Neurology</option> <option value="422">Psychiatry, Research</option> <option value="157">Psychiatry, Sleep Disorder</option> <option value="140">Psychologist</option> <option value="409">Psychosomatic Medicine</option> <option value="125">Public Health</option> <option value="127">Pulmonary Disease, Critical Care</option> <option value="206">Pulmonary Disease, Critical Care / Sleep</option> <option value="126">Pulmonary Disease, General</option> <option value="77">Pulmonary Disease, Sleep</option> <option value="48">Pulmonology</option> <option value="49">Radiation Oncology</option> <option value="277">Radiation, General</option> <option value="81">Radiology, Abdominal</option> <option value="253">Radiology, Body Imaging</option> <option value="317">Radiology, Breast Imaging</option> <option value="389">Radiology, Cardiac Imaging</option> <option value="387">Radiology, Cardiac Imaging</option> <option value="413">Radiology, Cardiothoracic Imaging</option> <option value="412">Radiology, Cardiovascular</option> <option value="414">Radiology, Chest</option> <option value="415">Radiology, Cross Sectional</option> <option value="174">Radiology, CT</option> <option value="287">Radiology, Diag: General</option> <option value="50">Radiology, Diag: Inv/Intervent</option> <option value="51">Radiology, Diag: Noninvasive</option> <option value="416">Radiology, Emergency</option> <option value="352">Radiology, General</option> <option value="318">Radiology, Interventional</option> <option value="171">Radiology, Mammography</option> <option value="149">Radiology, MRI</option> <option value="319">Radiology, MSK Imaging</option> <option value="103">Radiology, Musculoskeletal</option> <option value="400">Radiology, Neuro</option> <option value="145">Radiology, Neuro - Diagnostic</option> <option value="355">Radiology, Neuro-Interventional</option> <option value="30">Radiology, Nuclear</option> <option value="119">Radiology, Pediatric</option> <option value="417">Radiology, Thoracic</option> <option value="418">Radiology, Trauma</option> <option value="376">Radiology, Ultrasound</option> <option value="419">Radiology, Vascular/Interventional </option> <option value="360">Radiology, Women's Imager</option> <option value="377">Reproductive Endocrinology and Fertility</option> <option value="179">Research</option> <option value="53">Rheumatology</option> <option value="378">Sleep Medicine</option> <option value="128">Spinal Cord Injury Medicine</option> <option value="129">Sports Medicine, EM</option> <option value="130">Sports Medicine, FM</option> <option value="54">Sports Medicine, General</option> <option value="131">Sports Medicine, IM</option> <option value="107">Sports Medicine, Orthopedic</option> <option value="379">Sports Medicine, Rehab</option> <option value="158">Surgery, Bariatrics</option> <option value="185">Surgery, Breast</option> <option value="209">Surgery, Breast: Oncology</option> <option value="86">Surgery, Burn</option> <option value="169">Surgery, Cardiothoracic</option> <option value="358">Surgery, Cardiothoracic: Thoraco-Abdominal</option> <option value="359">Surgery, Cardiothoracic:Advanced Aortic</option> <option value="59">Surgery, Cardiovascular</option> <option value="226">Surgery, Cardiovascular & Thoracic</option> <option value="60">Surgery, Colon and Rectal</option> <option value="87">Surgery, Craniofacial</option> <option value="142">Surgery, Critical Care</option> <option value="380">Surgery, Dental</option> <option value="217">Surgery, Dermatologic</option> <option value="239">Surgery, Endo</option> <option value="216">Surgery, Endocrine and Oncological</option> <option value="143">Surgery, Facial Plastic</option> <option value="80">Surgery, GastroIntestinal/Colorectal</option> <option value="61">Surgery, General</option> <option value="18">Surgery, General: Hand</option> <option value="163">Surgery, Head & Neck</option> <option value="214">Surgery, Invasive</option> <option value="181">Surgery, Laparoscopic</option> <option value="255">Surgery, Laser</option> <option value="62">Surgery, Maxillofacial</option> <option value="395">Surgery, Minimally Invasive</option> <option value="29">Surgery, Neurosurgical</option> <option value="272">Surgery, Neurosurgical: Vascular</option> <option value="381">Surgery, OB / GYN</option> <option value="254">Surgery, Oculoplastic</option> <option value="132">Surgery, Oncology</option> <option value="382">Surgery, Ophthalmology</option> <option value="71">Surgery, Oral</option> <option value="222">Surgery, Oral and Maxillofacial</option> <option value="56">Surgery, Ortho: Foot and Ankle</option> <option value="64">Surgery, Ortho: General</option> <option value="96">Surgery, Ortho: Hand</option> <option value="231">Surgery, Ortho: Hip and Knee</option> <option value="57">Surgery, Ortho: Joint replacement</option> <option value="146">Surgery, Ortho: Muscular</option> <option value="353">Surgery, Ortho: Neuro</option> <option value="172">Surgery, Ortho: Pediatric</option> <option value="230">Surgery, Ortho: Shoulder and Elbow</option> <option value="58">Surgery, Ortho: Spine</option> <option value="173">Surgery, Ortho: Sports</option> <option value="108">Surgery, Ortho: Trauma</option> <option value="383">Surgery, Otorhinolaryngology</option> <option value="72">Surgery, Pediatric</option> <option value="55">Surgery, Pediatric Cardiovascular</option> <option value="180">Surgery, Pediatric: Cardiothoracic</option> <option value="225">Surgery, Pediatric: Neurosurgical</option> <option value="315">Surgery, Pediatric: Plastic</option> <option value="68">Surgery, Peripheral Vascular</option> <option value="65">Surgery, Plastic</option> <option value="218">Surgery, Plastic: Cosmetic</option> <option value="198">Surgery, Plastic: Facial</option> <option value="97">Surgery, Plastic: Hand</option> <option value="357">Surgery, Plastic: Microvascular</option> <option value="234">Surgery, Plastic: Reconstructive</option> <option value="159">Surgery, Reconstructive</option> <option value="156">Surgery, Renal Transplant</option> <option value="410">Surgery, Skull</option> <option value="66">Surgery, Thoracic</option> <option value="67">Surgery, Thoracic and Vascular</option> <option value="197">Surgery, Transplant</option> <option value="388">Surgery, Transplant: Bone Marrow</option> <option value="133">Surgery, Trauma</option> <option value="212">Surgery, Urology</option> <option value="69">Surgery, Vascular</option> <option value="211">Surgery, Vitreoretinal</option> <option value="411">Toxicology, General</option> <option value="134">Urgent Care</option> <option value="384">Urgent Care, Occupational Health</option> <option value="330">Urogynecology</option> <option value="177">Urology, Endo</option> <option value="73">Urology, General</option> <option value="135">Womens Health</option> <option value="282">Wound Care</option> </select> </div> <div class="formBlock"> <label for="field20" class="column110px">City<span class="required">*</span></label> <input class="text_required" id="Person_HomeAddress_City" maxlength="75" name="Person.HomeAddress.City" type="text" value=""/> <label for="field21" class="column60px">State<span class="required">*</span></label> <select class="dropAuto_required" id="Person_HomeAddress_State" name="Person.HomeAddress.State"><option value="">Choose ..</option> <option value="AA">Armed Forces Americas</option> <option value="AB">Alberta</option> <option value="AE">Armed Forces Europe</option> <option value="AK">Alaska</option> <option value="AL">Alabama</option> <option value="AP">Armed Forces Pacific</option> <option value="AR">Arkansas</option> <option value="AS">American Samoa</option> <option value="AZ">Arizona</option> <option value="BC">British Columbia</option> <option value="CA">California</option> <option value="CO">Colorado</option> <option value="CT">Connecticut</option> <option value="DC">District Of Columbia</option> <option value="DE">Delaware</option> <option value="FL">Florida</option> <option value="FM">Federated States, Micronesia</option> <option value="GA">Georgia</option> <option value="GU">Guam</option> <option value="HI">Hawaii</option> <option value="IA">Iowa</option> <option value="ID">Idaho</option> <option value="IL">Illinois</option> <option value="IN">Indiana</option> <option value="KS">Kansas</option> <option value="KY">Kentucky</option> <option value="LA">Louisiana</option> <option value="MA">Massachusetts</option> <option value="MB">Manitoba</option> <option value="MD">Maryland</option> <option value="ME">Maine</option> <option value="MH">Marshall Islands</option> <option value="MI">Michigan</option> <option value="MN">Minnesota</option> <option value="MO">Missouri</option> <option value="MP">Northern Mariana Islands</option> <option value="MS">Mississippi</option> <option value="MT">Montana</option> <option value="NB">New Brunswick</option> <option value="NC">North Carolina</option> <option value="ND">North Dakota</option> <option value="NE">Nebraska</option> <option value="NF">Newfoundland and Labrador</option> <option value="NH">New Hampshire</option> <option value="NJ">New Jersey</option> <option value="NM">New Mexico</option> <option value="NS">Nova Scotia</option> <option value="NT">Northwest Territories</option> <option value="NU">Nunavut</option> <option value="NV">Nevada</option> <option value="NY">New York</option> <option value="OH">Ohio</option> <option value="OK">Oklahoma</option> <option value="ON">Ontario</option> <option value="OR">Oregon</option> <option value="OU">Outside U.S. & Territories</option> <option value="PA">Pennsylvania</option> <option value="PE">Prince Edward Island</option> <option value="PR">Puerto Rico</option> <option value="PW">Palau</option> <option value="QC">Quebec</option> <option value="RI">Rhode Island</option> <option value="SC">South Carolina</option> <option value="SD">South Dakota</option> <option value="SK">Saskatchewan</option> <option value="TN">Tennessee</option> <option value="TX">Texas</option> <option value="UT">Utah</option> <option value="VA">Virginia</option> <option value="VI">Virgin Islands</option> <option value="VT">Vermont</option> <option value="WA">Washington</option> <option value="WI">Wisconsin</option> <option value="WV">West Virginia</option> <option value="WY">Wyoming</option> <option value="YT">Yukon Territory</option> </select> <label for="field22" class="column60px">Zip</label> <input class="zip_mask" id="Person_HomeAddress_Zip" name="Person.HomeAddress.Zip" type="text" value=""/> </div> <div class="formBlock"> <label for="field23" class="column110px">Country</label> <select class="dropAuto" id="Person_HomeAddress_Country" name="Person.HomeAddress.Country" onchange="setCountryMasks( document.getElementById('Person_HomePhone_Value'), this.value);setCountryMasks( document.getElementById('Person_MobilePhone_Value'), this.value);setCountryMasks( document.getElementById('Person_HomeAddress_Zip'), this.value);"><option value="">Choose ..</option> <option value="AFG">Afghanistan</option> <option value="ALB">Albania</option> <option value="DZA">Algeria</option> <option value="ASM">American Samoa</option> <option value="AND">Andorra</option> <option value="AGO">Angola</option> <option value="AIA">Anguilla</option> <option value="ATA">Antarctica</option> <option value="ATG">Antigua and Barbuda</option> <option value="ARG">Argentina</option> <option value="ARM">Armenia</option> <option value="ABW">Aruba</option> <option value="AUS">Australia</option> <option value="AUT">Austria</option> <option value="AZE">Azerbaijan</option> <option value="BHS">Bahamas</option> <option value="BHR">Bahrain</option> <option value="BGD">Bangladesh</option> <option value="BRB">Barbados</option> <option value="BLR">Belarus</option> <option value="BEL">Belgium</option> <option value="BLZ">Belize</option> <option value="BEN">Benin</option> <option value="BMU">Bermuda</option> <option value="BTN">Bhutan</option> <option value="BOL">Bolivia</option> <option value="BIH">Bosnia and Herzegowina</option> <option value="BWA">Botswana</option> <option value="BVT">Bouvet Island</option> <option value="BRA">Brazil</option> <option value="IOT">British Indian Ocean Territory</option> <option value="BRN">Brunei Darussalam</option> <option value="BGR">Bulgaria</option> <option value="BFA">Burkina Faso</option> <option value="BDI">Burundi</option> <option value="KHM">Cambodia</option> <option value="CMR">Cameroon</option> <option value="CAN">Canada</option> <option value="CPV">Cape Verde</option> <option value="CYM">Cayman Islands</option> <option value="CAF">Central African Republic</option> <option value="TCD">Chad</option> <option value="CHL">Chile</option> <option value="CHN">China</option> <option value="CXR">Christmas Island</option> <option value="CCK">Cocos (Keeling) Islands</option> <option value="COL">Colombia</option> <option value="COM">Comoros</option> <option value="COG">Congo</option> <option value="COD">Congo - The Democratic Republic of the</option> <option value="COK">Cook Islands</option> <option value="CRI">Costa Rica</option> <option value="CIV">Cote D`Ivoire</option> <option value="HRV">Croatia (Hrvatska)</option> <option value="CUB">Cuba</option> <option value="CYP">Cyprus</option> <option value="CZE">Czech Republic</option> <option value="DNK">Denmark</option> <option value="DJI">Djibouti</option> <option value="DMA">Dominica</option> <option value="DOM">Dominican Republic</option> <option value="TMP">East Timor</option> <option value="ECU">Ecuador</option> <option value="EGY">Egypt</option> <option value="SLV">El Salvador</option> <option value="ENG">England</option> <option value="GNQ">Equatorial Guinea</option> <option value="ERI">Eritrea</option> <option value="EST">Estonia</option> <option value="ETH">Ethiopia</option> <option value="FLK">Falkland Islands (Malvinas)</option> <option value="FRO">Faroe Islands</option> <option value="FJI">Fiji</option> <option value="FIN">Finland</option> <option value="FRA">France</option> <option value="FXX">France - Metropolitan</option> <option value="GUF">French Guiana</option> <option value="PYF">French Polynesia</option> <option value="ATF">French Southern Territories</option> <option value="GAB">Gabon</option> <option value="GMB">Gambia</option> <option value="GEO">Georgia</option> <option value="DEU">Germany</option> <option value="GHA">Ghana</option> <option value="GIB">Gibraltar</option> <option value="GRC">Greece</option> <option value="GRL">Greenland</option> <option value="GRD">Grenada</option> <option value="GLP">Guadeloupe</option> <option value="GUM">Guam</option> <option value="GTM">Guatemala</option> <option value="GIN">Guinea</option> <option value="GNB">Guinea-Bissau</option> <option value="GUY">Guyana</option> <option value="HTI">Haiti</option> <option value="HMD">Heard and Mc Donald Islands</option> <option value="HND">Honduras</option> <option value="HKG">Hong Kong</option> <option value="HUN">Hungary</option> <option value="ISL">Iceland</option> <option value="IND">India</option> <option value="IDN">Indonesia</option> <option value="IRN">Iran (Islamic Republic of)</option> <option value="IRQ">Iraq</option> <option value="IRL">Ireland</option> <option value="ISR">Israel</option> <option value="ITA">Italy</option> <option value="JAM">Jamaica</option> <option value="JPN">Japan</option> <option value="JOR">Jordan</option> <option value="KAZ">Kazakhstan</option> <option value="KEN">Kenya</option> <option value="KIR">Kiribati</option> <option value="PRK">Korea - Democratic People`s Republic of</option> <option value="KOR">Korea - Republic of</option> <option value="KWT">Kuwait</option> <option value="KGZ">Kyrgyzstan</option> <option value="LAO">Lao - People`s Democratic Republic</option> <option value="LVA">Latvia</option> <option value="LBN">Lebanon</option> <option value="LSO">Lesotho</option> <option value="LBR">Liberia</option> <option value="LBY">Libyan Arab Jamahiriya</option> <option value="LIE">Liechtenstein</option> <option value="LTU">Lithuania</option> <option value="LUX">Luxembourg</option> <option value="MAC">Macau</option> <option value="MKD">Macedonia - The Former Yugoslav Republic</option> <option value="MDG">Madagascar</option> <option value="MWI">Malawi</option> <option value="MYS">Malaysia</option> <option value="MDV">Maldives</option> <option value="MLI">Mali</option> <option value="MLT">Malta</option> <option value="MHL">Marshall Islands</option> <option value="MTQ">Martinique</option> <option value="MRT">Mauritania</option> <option value="MUS">Mauritius</option> <option value="MYT">Mayotte</option> <option value="MEX">Mexico</option> <option value="FSM">Micronesia - Federated States of</option> <option value="MDA">Moldova - Republic of</option> <option value="MCO">Monaco</option> <option value="MNG">Mongolia</option> <option value="MSR">Montserrat</option> <option value="MAR">Morocco</option> <option value="MOZ">Mozambique</option> <option value="MMR">Myanmar</option> <option value="NAM">Namibia</option> <option value="NRU">Nauru</option> <option value="NPL">Nepal</option> <option value="NLD">Netherlands</option> <option value="ANT">Netherlands Antilles</option> <option value="NCL">New Caledonia</option> <option value="NZL">New Zealand</option> <option value="NIC">Nicaragua</option> <option value="NER">Niger</option> <option value="NGA">Nigeria</option> <option value="NIU">Niue</option> <option value="NFK">Norfolk Island</option> <option value="NIR">Northern Ireland</option> <option value="MNP">Northern Mariana Islands</option> <option value="NOR">Norway</option> <option value="OMN">Oman</option> <option value="PAK">Pakistan</option> <option value="PLW">Palau</option> <option value="PSE">Palestinian</option> <option value="PAN">Panama</option> <option value="PNG">Papua New Guinea</option> <option value="PRY">Paraguay</option> <option value="PER">Peru</option> <option value="PHL">Philippines</option> <option value="PCN">Pitcairn</option> <option value="POL">Poland</option> <option value="PRT">Portugal</option> <option value="PRI">Puerto Rico</option> <option value="QAT">Qatar</option> <option value="REU">Reunion</option> <option value="ROM">Romania</option> <option value="RUS">Russian Federation</option> <option value="RWA">Rwanda</option> <option value="KNA">Saint Kitts and Nevis</option> <option value="LCA">Saint Lucia</option> <option value="VCT">Saint Vincent and The Grenadines</option> <option value="WSM">Samoa</option> <option value="SMR">San Marino</option> <option value="STP">Sao Tome and Principe</option> <option value="SAU">Saudi Arabia</option> <option value="SCO">Scotland</option> <option value="SEN">Senegal</option> <option value="SYC">Seychelles</option> <option value="SLE">Sierra Leone</option> <option value="SGP">Singapore</option> <option value="SVK">Slovakia (Slovak Republic)</option> <option value="SVN">Slovenia</option> <option value="SLB">Solomon Islands</option> <option value="SOM">Somalia</option> <option value="ZAF">South Africa</option> <option value="SGS">South Georgia and South Sandwich Islands</option> <option value="ESP">Spain</option> <option value="LKA">Sri Lanka</option> <option value="SHN">St. Helena</option> <option value="SPM">St. Pierre and Miquelon</option> <option value="SDN">Sudan</option> <option value="SUR">Suriname</option> <option value="SJM">Svalbard and Jan Mayen Islands</option> <option value="SWZ">Swaziland</option> <option value="SWE">Sweden</option> <option value="CHE">Switzerland</option> <option value="SYR">Syrian Arab Republic</option> <option value="TWN">Taiwan - Province of China</option> <option value="TJK">Tajikistan</option> <option value="TZA">Tanzania - United Republic of</option> <option value="THA">Thailand</option> <option value="TGO">Togo</option> <option value="TKL">Tokelau</option> <option value="TON">Tonga</option> <option value="TTO">Trinidad and Tobago</option> <option value="TUN">Tunisia</option> <option value="TUR">Turkey</option> <option value="TKM">Turkmenistan</option> <option value="TCA">Turks and Caicos Islands</option> <option value="TUV">Tuvalu</option> <option value="UGA">Uganda</option> <option value="UKR">Ukraine</option> <option value="ARE">United Arab Emirates</option> <option value="GBR">United Kingdom</option> <option selected="selected" value="USA">United States</option> <option value="URY">Uruguay</option> <option value="UZB">Uzbekistan</option> <option value="VUT">Vanuatu</option> <option value="VAT">Vatican City State</option> <option value="VEN">Venezuela</option> <option value="VNM">Viet Nam</option> <option value="VGB">Virgin Islands (British)</option> <option value="VIR">Virgin Islands (U.S.)</option> <option value="WAL">Wales</option> <option value="WLF">Wallis and Futuna Islands</option> <option value="ESH">Western Sahara</option> <option value="YEM">Yemen</option> <option value="YUG">Yugoslavia</option> <option value="ZMB">Zambia</option> <option value="ZWE">Zimbabwe</option> </select> </div> </div> <div class="formBlock"> <label for="field12" class="column110px">Preferred Phone Number<span class="required">*</span></label> <input class="phone_mask" id="Person_HomePhone_Value" name="Person.HomePhone.Value" type="text" value=""/> </div> <div class="formBlock"> <label class="outer"><input name="updates" type="checkbox" value="true"/><input name="updates" type="hidden" value="false"/></label>  I would like to receive periodic email updates on available positions at Fairview Health Services. </div> <div class="formBlock"> <label class="outer"><input id="signed" name="signed" type="checkbox" value="true" class="required"/><input name="signed" type="hidden" value="false"/>*</label> I have read, and I accept, Fairview Health Services's <a href="https://web.archive.org/web/20110627185711/http://www.fairview.org/about/S_013969">terms of use</a>. <br/><br/><font class="requiredFields" size="2">*  Required fields</font> <div style="text-align:right; margin-top: 20px;"> <div class="error" id="register_errors" style="text-align: left; height: 0px;"></div> </div> </div> <div class="formBlock"> <input name="submit" type="submit" value="Save 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