TUSPM Great Exchange Seekers Registration
Buying or Joining a Practice

Date:

Your goal:
Associate position.
Purchase a practice.
Other


Please include my information on the list of podiatrists looking for positions or practices and keep me informed of new opportunities.
Do not include my name on the list of podiatrists looking for positions or practices but send me the Sellers list and keep me informed of new opportunities.

First Name: Last Name: MI:
Street Address:
City:
State or Province:   Zip Code:
Office Phone: Home Phone: Fax:
Email address:
Website URL:
School:
Graduation year:
Residency years and locations:
                                                     
                                                     

Please list the geographical areas that you are willing to consider:

Other information to include with your name on the Great Exchange list:

If you prefer, fill out the form, print it and mail or fax to:
Mail:
Alumni Relations Office
TUSPM
8th and Race Streets
Philadelphia, PA 19107
Fax:
215-922-7830

If you have questions regarding this form, you may contact Dave Burt at 215-625-5248 or email at great.exchange@temple.edu.

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