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Nurse Aide / Med Aide
GIVE TO CAREPAC
FIND A FACILITY
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Registration Form Unique ID
Registration Form Facility Name
Date Format: MM slash DD slash YYYY
Is the attendee a nurse?
Nursing License #
Is the attendee an Administrator?
Special Assistance or Accessibility:
Consent to Release Information
By participating in this activity, you grant NNFA/NALA/LPNAN the right to release your contact information to a sponsor/commercial interest organization. If you do not wish to have your name, mailing address, and email address released, please select that option below.
I do not wish to have my name, mailing address, and/or email address released.
Photographs are taken during NNFA/NALA/LPNAN events for use in media releases, newsletters, and other promotional materials, whether in print, electronic, or other media, including the NHCA website and online social networking sites. By participating in this event, you grant NNFA/NALA/LPNAN the right to use your name and photograph for such purposes.
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