2020-2021 Nurse Talks Volunteer Champion Sign-up Question Title * 1. Member Name: OK Question Title * 2. Member Phone # OK Question Title * 3. Member Email Address OK Question Title * 4. I'm interested in championing the following dates - choose all that apply (topics are subject to change) September 24: COVID-19: Contact Tracing, EPI and Ethics October 8: COVID-19: Information Hygiene and Viral Rumors November 12: EHR Errors January 14: Implicit Bias February 11: Health Care Disparities April 8: Mental Health - Post Traumatic Stress and the Impact on Nursing May 13: Long-Term Health Effects of COVID-19 OK Question Title * 5. Please provide information on the facility or business where you will be championing the webcast(s) Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK DONE