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1. Email Blast List Registration, fill in & click done to start receiving email announcments

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* 1. First Name

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* 2. Middle Initial

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* 3. Last Name

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* 4. What licenses do you hold? (i.e. RN, MD, SW, etc.)

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* 5. What are your professional credentials? (i.e. PhD, MSN, BSN, LMSW, BA, etc.)

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* 6. Your employer's Name

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* 7. Your job title

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* 8. Work address

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* 9. Your work City, St & Zip

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* 10. Your home address

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* 11. Home City

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* 12. Home State (please abbreviate)

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* 13. Home Zip Code

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* 14. What is your preferred mailing address?

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* 15. Provide your primary email address

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* 16. Provide a secondary email address
if you don't have one go to next question

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* 17. What is your medical specialty? (i.e.pediatrics, geriatrics, diabetes, obgyn, etc.)

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* 18. What topics interest you?(i.e. Nursing Skills, Leadership, Medical Updates, Women's Health, etc. feel free to add your own topics)

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* 19. Please click yes if we can include you on all of our email announcements by sending an email.
Click no if you do not allow us to email you (we will remove you from the list)

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