Nurse Think Tank Interest form
Activism and the Art of Nursing - July 13-14, Augusta, GA.

Information collected here will never be sold. This information is being collected to solicit interest and coordinate logistics.

What is your name? *
What is your email address? *
What is your cell phone number?
Tell us about you! *
Tell us about why you are interested in participating in our Nurse Activism Think Tank. *
Do you have special talents you'd like to share?
What region are you from? *
If you chose "Outside the US" for your last response, where are you coming from? *
How definite is your attendance? *
I'm hoping to attend but seems unlikely
I AM THERE!
How will you arrive?
Willing to carpool and/or share accommodations?
Can we share your responses to facilitate organization? *
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