AANA 2021-22 Fellowship Education Subscription Series

All fields marked with * are required and must be completed.

Program Information

Program Name *

Program Director Name *

First Name Middle Name Last Name Suffix/Degree(s)

Program Director Email *

example@example.com

Program Director Phone

Country Code Area Code Phone Number

I plan to have my trainees watch the webinars: *

Program Coordinator Name *

First Name Middle Name Last Name Suffix

Program Coordinator Email *

example@example.com

Program Coordinator Phone

Country Code Area Code Phone Number

Program Year *

Program Selection: *

One to Three Program Participants Four to Six Program Participants Seven to Twelve Program Participants

Program Participants Information (Names and emails of Program Participants cannot be changed following sign-up):

Program Participant One Name:

Program Participant One Email:

example@example.com

Program Participant Two Name:

Program Participant Two Email:

example@example.com

Program Participant Three Name:

Program Participant Three Email:

example@example.com

Program Participant Four Name:

Program Participant Four Email:

example@example.com

Program Participant Five Name:

Program Participant Five Email:

example@example.com

Program Participant Six Name:

Program Participant Six Email:

example@example.com

Program Participant Seven Name:

Program Participant Seven Email:

example@example.com

Program Participant Eight Name:

Program Participant Eight Email:

example@example.com

Program Participant Nine Name:

Program Participant Nine Email:

example@example.com

Program Participant Ten Name:

Program Participant Ten Email:

example@example.com

Program Participant Eleven Name:

Program Participant Eleven Email:

example@example.com

Program Participant Twelve Name:

Program Participant Twelve Email:

example@example.com

Program Agreement:
I agree by completing this form that I am signing up the Program Participants in my program as entered in this form as registrants in AANA’s Fellowship Education Subscription.

I understand if I am enrolling after the start of the series that my Program’s Participants will be given access to the recordings of all webinars that have taken place to date.

I have read and understood the Program Agreement *

I agree