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	<title>2026 Dr's Dilemma Registration Form | New York Chapter of the American College of Physicians</title>


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			<p class="form-instructions"><table border="0" cellpadding="10" cellspacing="2" style="width: 100%;">
	<tbody>
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			<td style="vertical-align: top;">
			<p><span class="subtitle">NYACP Dr&#39;s Dilemma Team Registration</span></p>

			<p>The 2026 NYACP Drs Dilemma competition will take place on:</p>

			<p><span class="subtitle">Friday, October 23, 2026<br />
			2:00 - 5:30 pm</span></p>

			<p>Crowne Plaza/Desmond Hotel<br />
			660 Albany Shaker Road<br />
			Albany, NY&nbsp; 12211</p>
			</td>
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</table>
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  			}
 		}

		addLoadEvent(calcTotalFix);
	
</script>

	
<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
</style>


<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
		iTemp = strFileName.indexOf(":");
		
		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
		}
		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				obj.value = '';
				return false;
			}
		}
	}
	function clearRadio(rd) {
		if (document.iform) {
			var v;
			var ln;
			var ev;
			submitted = 0;
			v = "document.iform." + rd + ".length";
			ln = eval(v);
			// This will ensure we uncheck if there is only 1 radio button..
			v = "document.iform." + rd + ".checked = false;";
			ev = eval(v);
			// Now loop through the list of radio buttons and uncheck them all
			for (i=0;i<ln;i++) {
				v = "document.iform." + rd + "[" + i + "].checked = false;";
				//console.log(v);
				ev = eval(v);
			}
			calcTotalFix();
		}
	}
</script>


<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12729" class="layout form item outer row-1 item-12729 row_num-20 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Program Director or Team Captain
					

							<input type="text"
								
									id="response_1"
									name="response_1"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-1 item-12729"
							><!-- input -->

							
				<input type="hidden" name="question_1" value="Program Director or Team Captain">
				<INPUT TYPE="hidden" NAME="response_1_question_id" VALUE="12729">
				<INPUT TYPE="hidden" NAME="question_type_1" value="Text">
				<INPUT TYPE="hidden" NAME="label_1" value="Program Director">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12730" class="layout form item outer row-2 item-12730 row_num-20 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Program Director/Team Captain Email Address
					

							<input type="text"
								
									id="response_2"
									name="response_2"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-2 item-12730"
							><!-- input -->

							
				<input type="hidden" name="question_2" value="Program Director/Team Captain Email Address">
				<INPUT TYPE="hidden" NAME="response_2_question_id" VALUE="12730">
				<INPUT TYPE="hidden" NAME="question_type_2" value="Text">
				<INPUT TYPE="hidden" NAME="label_2" value="Program Director Ema">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12727" class="layout form item outer row-3 item-12727 row_num-40 row_pos-80 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Residency Program<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-3 item-12727"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_3_required"
							VALUE="The field Residency Program is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_3" value="Residency Program ">
				<INPUT TYPE="hidden" NAME="response_3_question_id" VALUE="12727">
				<INPUT TYPE="hidden" NAME="question_type_3" value="Text">
				<INPUT TYPE="hidden" NAME="label_3" value="Residency Program">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12719" class="layout form item outer row-4 item-12719 row_num-60 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							City<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:156px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-4 item-12719"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_4_required"
							VALUE="The field City is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_4" value="City">
				<INPUT TYPE="hidden" NAME="response_4_question_id" VALUE="12719">
				<INPUT TYPE="hidden" NAME="question_type_4" value="Text">
				<INPUT TYPE="hidden" NAME="label_4" value="City">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12720" class="layout form item outer row-5 item-12720 row_num-60 row_pos-160 rowlength-2 type-StateSelect" style="max-width:50%;position:relative;">

			<div class="inner">

				
							State<span class="text-danger"> *</span>
					

								<select
									id="response_5"
									name="response_5"
									
									
									class="form-control type-StateSelect row-5 item-12720"
									>
									
									
										<option value="AB" >AB</option>
									
										<option value="AK" >AK</option>
									
										<option value="AL" >AL</option>
									
										<option value="AR" >AR</option>
									
										<option value="AZ" >AZ</option>
									
										<option value="BC" >BC</option>
									
										<option value="CA" >CA</option>
									
										<option value="CO" >CO</option>
									
										<option value="CT" >CT</option>
									
										<option value="DC" >DC</option>
									
										<option value="DE" >DE</option>
									
										<option value="FL" >FL</option>
									
										<option value="GA" >GA</option>
									
										<option value="HI" >HI</option>
									
										<option value="IA" >IA</option>
									
										<option value="ID" >ID</option>
									
										<option value="IL" >IL</option>
									
										<option value="IN" >IN</option>
									
										<option value="KS" >KS</option>
									
										<option value="KY" >KY</option>
									
										<option value="LA" >LA</option>
									
										<option value="MA" >MA</option>
									
										<option value="MB" >MB</option>
									
										<option value="MD" >MD</option>
									
										<option value="ME" >ME</option>
									
										<option value="MI" >MI</option>
									
										<option value="MN" >MN</option>
									
										<option value="MO" >MO</option>
									
										<option value="MS" >MS</option>
									
										<option value="MT" >MT</option>
									
										<option value="NB" >NB</option>
									
										<option value="NC" >NC</option>
									
										<option value="ND" >ND</option>
									
										<option value="NE" >NE</option>
									
										<option value="NF" >NF</option>
									
										<option value="NH" >NH</option>
									
										<option value="NJ" >NJ</option>
									
										<option value="NM" >NM</option>
									
										<option value="NV" >NV</option>
									
										<option value="NY" SELECTED>NY</option>
									
										<option value="OH" >OH</option>
									
										<option value="OK" >OK</option>
									
										<option value="ON" >ON</option>
									
										<option value="OR" >OR</option>
									
										<option value="PA" >PA</option>
									
										<option value="PE" >PE</option>
									
										<option value="PQ" >PQ</option>
									
										<option value="PR" >PR</option>
									
										<option value="RI" >RI</option>
									
										<option value="SC" >SC</option>
									
										<option value="SD" >SD</option>
									
										<option value="SK" >SK</option>
									
										<option value="TN" >TN</option>
									
										<option value="TX" >TX</option>
									
										<option value="UT" >UT</option>
									
										<option value="VA" >VA</option>
									
										<option value="VT" >VT</option>
									
										<option value="WA" >WA</option>
									
										<option value="WI" >WI</option>
									
										<option value="WV" >WV</option>
									
										<option value="WY" >WY</option>
									
								</select>
							
							
						<INPUT
							TYPE="hidden"
							NAME="response_5_required"
							VALUE="The field State is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_5" value="State">
				<INPUT TYPE="hidden" NAME="response_5_question_id" VALUE="12720">
				<INPUT TYPE="hidden" NAME="question_type_5" value="StateSelect">
				<INPUT TYPE="hidden" NAME="label_5" value="State">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12716" class="layout form item outer row-6 item-12716 row_num-80 row_pos-80 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Please list team participants - 3 team members and 1 alternate.
					

							<input type="text"
								
									id="response_6"
									name="response_6"
								
								
								 style="width:156px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-6 item-12716"
							><!-- input -->

							
				<input type="hidden" name="question_6" value="Please list team participants - 3 team members and 1 alternate.
">
				<INPUT TYPE="hidden" NAME="response_6_question_id" VALUE="12716">
				<INPUT TYPE="hidden" NAME="question_type_6" value="Text">
				<INPUT TYPE="hidden" NAME="label_6" value="Participants ">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12728" class="layout form item outer row-7 item-12728 row_num-100 row_pos-80 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							All teams are required to submit one category with 5 questions for the competition.
Please list Category:
					

							<input type="text"
								
									id="response_7"
									name="response_7"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-7 item-12728"
							><!-- input -->

							
				<input type="hidden" name="question_7" value="All teams are required to submit one category with 5 questions for the competition.
Please list Category:">
				<INPUT TYPE="hidden" NAME="response_7_question_id" VALUE="12728">
				<INPUT TYPE="hidden" NAME="question_type_7" value="Text">
				<INPUT TYPE="hidden" NAME="label_7" value="Text">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12732" class="layout form item outer row-8 item-12732 row_num-120 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Question 1
					

							<input type="text"
								
									id="response_8"
									name="response_8"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-8 item-12732"
							><!-- input -->

							
				<input type="hidden" name="question_8" value="Question 1 ">
				<INPUT TYPE="hidden" NAME="response_8_question_id" VALUE="12732">
				<INPUT TYPE="hidden" NAME="question_type_8" value="Text">
				<INPUT TYPE="hidden" NAME="label_8" value="Question 1 And">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12737" class="layout form item outer row-9 item-12737 row_num-120 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Question 1 Answer
					

							<input type="text"
								
									id="response_9"
									name="response_9"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-9 item-12737"
							><!-- input -->

							
				<input type="hidden" name="question_9" value="Question 1 Answer">
				<INPUT TYPE="hidden" NAME="response_9_question_id" VALUE="12737">
				<INPUT TYPE="hidden" NAME="question_type_9" value="Text">
				<INPUT TYPE="hidden" NAME="label_9" value="Question 1 Answer">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12733" class="layout form item outer row-10 item-12733 row_num-140 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Question 2
					

							<input type="text"
								
									id="response_10"
									name="response_10"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-10 item-12733"
							><!-- input -->

							
				<input type="hidden" name="question_10" value="Question 2 ">
				<INPUT TYPE="hidden" NAME="response_10_question_id" VALUE="12733">
				<INPUT TYPE="hidden" NAME="question_type_10" value="Text">
				<INPUT TYPE="hidden" NAME="label_10" value="Question 2">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12738" class="layout form item outer row-11 item-12738 row_num-140 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Question 2 Answer
					

							<input type="text"
								
									id="response_11"
									name="response_11"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-11 item-12738"
							><!-- input -->

							
				<input type="hidden" name="question_11" value="Question 2 Answer">
				<INPUT TYPE="hidden" NAME="response_11_question_id" VALUE="12738">
				<INPUT TYPE="hidden" NAME="question_type_11" value="Text">
				<INPUT TYPE="hidden" NAME="label_11" value="Question 2 Answer">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12734" class="layout form item outer row-12 item-12734 row_num-160 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Question 3
					

							<input type="text"
								
									id="response_12"
									name="response_12"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-12 item-12734"
							><!-- input -->

							
				<input type="hidden" name="question_12" value="Question 3 ">
				<INPUT TYPE="hidden" NAME="response_12_question_id" VALUE="12734">
				<INPUT TYPE="hidden" NAME="question_type_12" value="Text">
				<INPUT TYPE="hidden" NAME="label_12" value="Question 3">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12739" class="layout form item outer row-13 item-12739 row_num-160 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Question 3 Answer
					

							<input type="text"
								
									id="response_13"
									name="response_13"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-13 item-12739"
							><!-- input -->

							
				<input type="hidden" name="question_13" value="Question 3 Answer">
				<INPUT TYPE="hidden" NAME="response_13_question_id" VALUE="12739">
				<INPUT TYPE="hidden" NAME="question_type_13" value="Text">
				<INPUT TYPE="hidden" NAME="label_13" value="Question 3 Answer">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12735" class="layout form item outer row-14 item-12735 row_num-180 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Question 4
					

							<input type="text"
								
									id="response_14"
									name="response_14"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-14 item-12735"
							><!-- input -->

							
				<input type="hidden" name="question_14" value="Question 4 ">
				<INPUT TYPE="hidden" NAME="response_14_question_id" VALUE="12735">
				<INPUT TYPE="hidden" NAME="question_type_14" value="Text">
				<INPUT TYPE="hidden" NAME="label_14" value="Question 4">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12740" class="layout form item outer row-15 item-12740 row_num-180 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Question 4 Answer
					

							<input type="text"
								
									id="response_15"
									name="response_15"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-15 item-12740"
							><!-- input -->

							
				<input type="hidden" name="question_15" value="Question 4 Answer">
				<INPUT TYPE="hidden" NAME="response_15_question_id" VALUE="12740">
				<INPUT TYPE="hidden" NAME="question_type_15" value="Text">
				<INPUT TYPE="hidden" NAME="label_15" value="Question 4 Answer">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12736" class="layout form item outer row-16 item-12736 row_num-200 row_pos-80 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Question 5
					

							<input type="text"
								
									id="response_16"
									name="response_16"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-16 item-12736"
							><!-- input -->

							
				<input type="hidden" name="question_16" value="Question 5 ">
				<INPUT TYPE="hidden" NAME="response_16_question_id" VALUE="12736">
				<INPUT TYPE="hidden" NAME="question_type_16" value="Text">
				<INPUT TYPE="hidden" NAME="label_16" value="Question 5">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-12741" class="layout form item outer row-17 item-12741 row_num-200 row_pos-160 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Question 5 Answer
					

							<input type="text"
								
									id="response_17"
									name="response_17"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-17 item-12741"
							><!-- input -->

							
				<input type="hidden" name="question_17" value="Question 5 Answer">
				<INPUT TYPE="hidden" NAME="response_17_question_id" VALUE="12741">
				<INPUT TYPE="hidden" NAME="question_type_17" value="Text">
				<INPUT TYPE="hidden" NAME="label_17" value="Question 5 Answer">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
</div><!-- /form_layout_wrapper -->


		<div id="_ssdiv2" style="display:none">
			<input type="hidden" id="fld_uploadfields" name="UploadFields" value="">
			<input type="hidden" id="fld_id_column" name="id_column" value="ID">
			<input type="hidden" id="fld_id_value" name="id_value" value="">
			<input type="hidden" id="fld_form_overrideid" name="form_overrideID" value="0">
			
			<input type="hidden" id="fld_ss_form_testid" name="ss_form_testid" value="0" />
			<div id="_ssdiv">
				<p style="background-color: blue"><input type="text" name="ss_firstname" value="" /></p>
			</div>
		</div>
		
			<input type="hidden" name="form_isEdit" value="0">
		
	
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