You can always press Enter⏎ to continue
NBS Latin America Taskforce - Webinar Speaker/Topic Survey
Educational Webinars In Spanish Survey
5
Questions
START
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
Physician - Neonatology
Physician - Neurology
Physician - Neurosurgery
Physician - Other
Scientist
Nurse
Advanced Practice Nurse
Allied Health Professional
Trainee
Student
Community Member
Affiliation
Workplace/Institution Name
Previous
Next
Submit
Press
Enter
2
Which topics would you like to be covered by the Task Force's activities?
Previous
Next
Submit
Press
Enter
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
Previous
Next
Submit
Press
Enter
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
Physician - Neonatology
Physician - Neurology
Physician - Neurosurgery
Physician - Other
Scientist
Nurse
Advanced Practice Nurse
Allied Health Professional
Trainee
Student
Community Member
Affiliation
Reason for Nomination
Previous
Next
Submit
Press
Enter
5
What topic would you like to address in your talk?
*
This field is required.
Previous
Next
Submit
Press
Enter
6
Do you have any additional suggestions on how the task force can improve our educational activities?
TextSize
Created with Sketch.
Huge
Large
Normal
Small
Bold
Created with Sketch.
Italic
Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
Created with Sketch.
quote
Created with Sketch.
Break
Created with Sketch.
Image
Created with Sketch.
Ok
Smiley
Created with Sketch.
Previous
Next
Submit
Press
Enter
7
Would you like to actively participate in NBS Latin America Task Force activities in the future?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
7
See All
Go Back
Submit