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BC (LOCAL) Elective Request
BC (LOCAL) Elective Request
Residents Name
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First
Last
Resident Email
*
Program Year
*
PGY1
PGY2
PGY3
PGY4
Block Number
*
Elective Name
*
Supervisor Name
*
First
Last
Supervisor Email
*
Hospital Site/City
*
Does local elective have call?
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No
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