Your Name Credentials (MD, DO, PA, NP) Email Address Phone Number Are You Employed by Beebe or Beebe Medical Group? Yes No List Your Fellowships / Additional Training Number of Years Practicing? What is Your Clinical or Non-Clinical Focus Area? Topics You Are Qualified to Present on: Have You Presented to Groups in the Past? Yes No When Was Your Last Presentation (month, year, topic) Your Bio (150-250 words to include medical degree, years practicing, and specialty areas) Choose a file One file only.100 MB limit.Allowed types: gif, jpg, png.