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Profile Details

Birthday

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Name (required)

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Woffice_Notes

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Location

This address will be used on the members directory map, please make sure this address is valid for Google Map.

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This address will be used on the members directory map, please make sure this address is valid for Google Map.

Years as an RN? (required)

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Google Map Location

This address will be used on the members directory map, please make sure this address is valid for Google Map.

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This address will be used on the members directory map, please make sure this address is valid for Google Map.

Street Address: (required)

Enter your street address.

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Enter your street address.

City: (required)

Enter your city.

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Enter your city.

State: (required)

Enter your State.

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Enter your State.

Zipcode: (required)

Enter your zip code.

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Enter your zip code.

Time Zone (PDT, MDT, CDT, EDT) (required)

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Phone Number: (required)

Enter your phone number.

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Enter your phone number.

Year of RN Degree:

Enter the year you earned your RN degree.

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Enter the year you earned your RN degree.

States where licensed: (required)

Enter the states where you are licensed to practice as an RN followed by a comma.

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Enter the states where you are licensed to practice as an RN followed by a comma.

Major practice areas: (required)

Select the practice areas that apply to you. Ctrl-click to select multiple items.

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Select the practice areas that apply to you. Ctrl-click to select multiple items.

Specialties and Certifications: (required)

Enter your specialties and certifications.

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Enter your specialties and certifications.

iRNPA Class Completion Date

Select the date you completed or will complete the iRNPA class. Class 12 enter: 11/08/2018

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Select the date you completed or will complete the iRNPA class. Class 12 enter: 11/08/2018

What is your principle reason(s) for becoming an independent RN Patient Advocate? * (required)

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