Neuro Nurse To Know Nomination Form 
Please join us in recognizing the incredible nurses that work in the various fields of neuroscience across the world to thank them for their hard work and to shed a light to the diversity of our specialty! Thank you for taking the time to nominate someone. 

Note: Self-nominations are accepted. Please note that the nominee's information will be shared on our social media platforms per their consent. We will be reaching out to them prior to doing so. 

By submitting this form you acknowledge you are aware that your information can be accessed by Google and that Google hosts their data outside Canada. If you have any concerns about this, feel free to submit your application to 
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Email *
Tell us about your nominee
Name *
Email *
Other contact information
Hospital *
Unit/Place of Work 
Tell us about your nominee and why they are so incredible! *
Nominator Name, Email and Contact Info *
Do you give us permission to share your nomination with the nominee? *
Do you give us permission to share your nomination in CANN platforms, including social media? *
Further instructions, questions, comments?
A copy of your responses will be emailed to the address you provided.
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