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2013
November
B
Berit Mila Course
Berit Mila Course
0%
Exit Survey
Thank you for your interest in out Berit Mila program.
In order to help us enroll you in our next course, please answer the questions to our short survey.
As we reach the number of students necessary, we will provide you with the dates of the next class.
Thank you very much for your interest in our program. Please start with the survey now by clicking on the
Continue
button below.
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First Name
:
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Last Name
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Address 1
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Address 2
:
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City
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State
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District of Columbia
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Zip
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Phone
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Email Address
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What is your profession ?
MD
DO
RN / Midwife
Other
What is your specialty (Select all that apply) If subspecialty, indicate in section for other?
Pediatrics
OB/GYN
Family Practice
Urology
Surgery
Other
What congregation do you currently belong?
Reform
Conservative
Reconstructionist
Modern Orthodox
Other
How did you learn of our program ?
Web search
Heard from a friend
Mentioned by my rabbi
Received information from mohel at a bris I attended
Other
Are you aware that our course in presented over a 12 week period online and with your local congregational rabbi's mentorship?
Yes
No
Other
What is your status in the following areas:
Active
Pending
Courtesy
Restricted
N/A
Medical license
Malpractice insurance
Synagogue or Temple membership
Are you currently proficient in newborn circumcisions ?
Yes
No
In process of learning
Other
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