Nurse Talks Volunteer Facilitator Sign-up Question Title * 1. Member Name: OK Question Title * 2. Member Phone # OK Question Title * 3. Member Email Address OK Question Title * 4. I'm interested in facilitating on the following dates - choose all that apply September 19: Nurse Satisfaction/Work Environment October 10: Nursing Policy/Advocacy November 14: Staffing January 9: TNA's Legislative Agenda February 13: Protecting Your Practice March 13: Workplace Violence April 10: Bullying/Incivility May 8: Disaster Preparedness June 12: Access to Care/Rural Health OK Question Title * 5. I will host Private event(s) (must invite a minimum of 5 nurses) Public event(s) (must be open to a minimum of 20 nurses) OK Question Title * 6. Please provide information on the facility, business or private residence where you will be facilitating the webcast(s) Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 7. Total number of nurses who can participate at this location OK DONE