Meeting day/date:
(i.e. every third Tuesday, or May 10th)

Place of meeting:
City:    State:

Topic:

This group is for (check all that apply):
Nursing Students
Nurses
Hospital/Clinic personnel
Everyone interested in topic
Other:

For more information:
Contact Person (must be filled in):
Phone (for our files, we prefer to not list your home phone number online):
E-mail (must be filled in):

Other information you would like included (i.e. brief description of content):