Information Requested in Call for Abstracts Survey

Please have abstract information and documentation ready before you begin the survey.

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* 1. What is your name?

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* 2. Please choose your role from the following:

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* 3. If applicable, enter type of nurse leader

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* 4. If applicable, enter role as interprofessional team member

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* 5. If applicable, enter type of student

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* 6. Which type of presentation would you like to be considered for?
Note: your project or study must be completed to be considered for a podium presentation or discussion session.

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* 7. First Author's Name, with credentials

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* 8. Mailing Address

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* 9. Email Address

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* 10. Phone Number

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* 11. Organizational Affiliation

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* 12. Name of 1st Author, Degree, License, Certifications, Role/Discipline

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* 13. Name(s) of Co-Presenter(s), Degree, License, Certifications, Role/Discipline

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* 14. Which type of abstract are you submitting?

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