NBS Latin America Taskforce - Webinar Speaker/Topic Survey

1
Your Information* This field is required.
Name
Email
Physician - Neonatology
Physician - Neurology
Physician - Neurosurgery
Physician - Other
Scientist
Nurse
Advanced Practice Nurse
Allied Health Professional
Trainee
Student
Community Member
Affiliation
Workplace/Institution Name
2
Which topics would you like to be covered by the Task Force's activities?
3
Would you like to volunteer to give a talk in Spanish or suggest a speaker to give a talk in Spanish?* This field is required.
Volunteer as a speaker
Suggest a speaker
None
4
Suggest a Speaker* This field is required.
Suggested Speaker's Name
Suggested Speaker's Email
Physician - Neonatology
Physician - Neurology
Physician - Neurosurgery
Physician - Other
Scientist
Nurse
Advanced Practice Nurse
Allied Health Professional
Trainee
Student
Community Member
Affiliation
Reason for Nomination
5
What topic would you like to address in your talk?* This field is required.
6
Do you have any additional suggestions on how the task force can improve our educational activities?
Huge
Large
Normal
Small
Ok
Ok
7
Would you like to actively participate in NBS Latin America Task Force activities in the future?* This field is required.
YESNO
Should be Empty: