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National Nursing Home COVID-19 Action Network
Please complete this form for EACH STAFF MEMBER that would like to attend this 16-week training
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Your Name
*
Your answer
Your Email
*
Your answer
Your Phone Number
*
Your answer
Your Job Title
*
Your answer
Organization Name
*
Your answer
Organization Address
*
Your answer
Which day/time do you prefer to attend the weekly training?
*
Tuesdays at 1pm
Thursdays at 3pm
I have no preference
I cannot attend either of these days and times
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