2019 Quality and Patient Experience Sharing Day Wait List

Thank you for your interest in attending this year's event, but we are currently at capacity. Please fill out the following fields to be placed on the wait list. As cancellations occur, we will will contact the next teammate on the list to be registered.

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* 1. Profile Information

First Name
Last Name

Organization

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Department ID (or Regional Facility Name)

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* 3. Type of Attendee

Gold Touchstone Winner

Silver Touchstone Winner

Bronze Touchstone Winner

General Attendee

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* 4. Are you a NAHQ member?

Yes

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* 5. Are you a RN?

Yes

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* 6. Do you have any specific food allergies or dietary restrictions?

None

Vegetarian

Vegan

Kosher

Gluten

Other (please specify)