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Request more information about PCOGS!

Are you practicing within Obstetrics, Gynecology or the Subspecialties in the Pacific Region?

Are you interested in learning more about PCOGS?

Complete this form below to tell us a little more about yourself.

*First name

*Last name

*Email

*What type of medicine do you currently practice? (Select all that apply)

General Obstetrics & Gynecology

Maternal Fetal Medicine

Reproductive Endocrinology and Infertility

Gynecology Oncology

Urogynecology and Reconstructive Pelvic Surgery

Family Planning

Minimally Invasive Gynecology

*What state/province do you reside & work in? (Note PCOGS Fellowship is only open to physicians practicing in these states/provinces.)

Alaska

Arizona

British Columbia

California

Hawaii

Idaho

Nevada

New Mexico

Oregon

Utah

Washington

*Are you currently board certified by the ABOG or AOBOG?

Yes

No

*Tell us a little about yourself, your practice within Obstetrics &/or Gynecology, and why you are interested in PCOGS:

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