Please tell us a little about yourself.

*Email:

*Password:

*Re-enter password:

Secondary email:

*First name:

*Last name:

*Current rank: O-3 O-4 O-5 O-6 O-7 or above Retiree (or other)

*Retirement year: 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970

*What rank did you retire at? O-3 O-4 O-5 O-6 O-7 or above

*Year promoted to current rank: 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970

*Date of birth: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924

*Gender: Male Female

*Where are you currently stationed? Far East/Pacific Islands/Alaska
Continental United States
European/African Theater
Middle East
Other

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Tell us about your experiences.

Which of the following experiences have you had? (select all that apply)

Land-based deployment
Shipboard tour/shipboard deployment
Assignment at an Overseas Duty Station
Assignment with the Marine Corps
Tour(s) as a Flight Surgeon
Tour(s) as a UMO/DMO
BUMED/HQMC or other Policy Role
Executive Medicine - CO, XO, Director
Prior Military Service
Residency Faculty
Residency Program Director

Of the following, which fellowships have you completed/are you currently in? (please select all that apply)

Fellowship Training - Acupuncture
Fellowship Training - Faculty Development
Fellowship Training - Geriatrics
Fellowship Training - Hospital Medicine
Fellowship Training - Obstetrics
Fellowship Training - Sports Medicine

Please tell us a little about yourself and your interests. (select all that apply)

Joined military medicine later in life
Has children
Actively involved in faith community
Experience transitioning to/from civilian life

For Those Looking For A Mentor

*Would you like to be matched with a mentor? Yes
No

Desired Mentor Experiences

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