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Salutation |
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Credentials (RN, MSN, etc): |
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Current Position / Role: |
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Select Current Position / Role |
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Educator |
Staff Nurse |
MDS Coordinator |
Director of Nursing |
Assistant Director of Nursing |
Administrator |
Clinical Consultant |
Other |
Corporate Clinical Director |
Other Nurse Executive/Healthcare Professional |
Physical Therapist |
Occupational Therapist |
Activities Director |
Dietician / Dietary Department |
Social Services Department |
Speech Therapist |
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Country |
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US | United States |
CA | Canada |
AF | Afghanistan |
AX | Aland Islands |
AL | Albania |
DZ | Algeria |
AS | American Samoa |
AD | Andorra |
AO | Angola |
AI | Anguilla |
AQ | Antarctica |
AG | Antigua and Barbuda |
AR | Argentina |
AM | Armenia |
AW | Aruba |
AU | Australia |
AT | Austria |
AZ | Azerbaijan |
BS | Bahamas |
BH | Bahrain |
BD | Bangladesh |
BB | Barbados |
BY | Belarus |
BE | Belgium |
BZ | Belize |
BJ | Benin |
BM | Bermuda |
BT | Bhutan |
BO | Bolivia |
BA | Bosnia and Herzegovina |
BW | Botswana |
BV | Bouvet Island |
BR | Brazil |
IO | British Indian Ocean Territory |
BN | Brunei Darussalam |
BG | Bulgaria |
BF | Burkina Faso |
BI | Burundi |
KH | Cambodia |
CM | Cameroon |
CV | Cape Verde |
KY | Cayman Islands |
CF | Central African Republic |
TD | Chad |
CL | Chile |
CN | China |
CX | Christmas island |
CC | Cocos (Keeling) Islands |
CO | Colombia |
KM | Comoros |
CG | Congo |
CD | Congo, The Democratic Republic of the |
CK | Cook Islands |
CR | Costa Rica |
CI | Côte D'ivoire |
HR | Croatia |
CU | Cuba |
CY | Cyprus |
CZ | Czech Republic |
DK | Denmark |
DJ | Djibouti |
DM | Dominica |
DO | Dominican Republic |
EC | Ecuador |
EG | Egypt |
SV | El Salvador |
GQ | Equatorial Guinea |
ER | Eritrea |
EE | Estonia |
ET | Ethiopia |
FK | Falkland Islands (Malvinas) |
FO | Faroe Islands |
FJ | Fiji |
FI | Finland |
FR | France |
GF | French Guiana |
PF | French Polynesia |
TF | French Southern Territories |
GA | Gabon |
GM | Gambia |
GE | Georgia |
DE | Germany |
GH | Ghana |
GI | Gibraltar |
GR | Greece |
GL | Greenland |
GD | Grenada |
GP | Guadeloupe |
GU | Guam |
GT | Guatemala |
GN | Guinea |
GW | Guinea-Bissau |
GY | Guyana |
HT | Haiti |
HM | Heard Island and McDonald Islands |
HN | Honduras |
HK | Hong Kong |
HU | Hungary |
IS | Iceland |
IN | India |
ID | Indonesia |
IR | Iran, Islamic Republic of |
IQ | Iraq |
IE | Ireland |
IL | Israel |
IT | Italy |
JM | Jamaica |
JP | Japan |
JO | Jordan |
KZ | Kazakhstan |
KE | Kenya |
KI | Kiribati |
KP | Korea, Democratic People's Republic of |
KR | Korea, Republic of |
KW | Kuwait |
KG | Kyrgyzstan |
LA | Lao People's Democratic Republic |
LV | Latvia |
LB | Lebanon |
LS | Lesotho |
LR | Liberia |
LY | Libyan Arab Jamahiriya |
LI | Liechtenstein |
LT | Lithuania |
LU | Luxembourg |
MO | Macao |
MK | Macedonia, the Former Yugoslav Republic of |
MG | Madagascar |
MW | Malawi |
MY | Malaysia |
MV | Maldives |
ML | Mali |
MT | Malta |
MH | Marshall Islands |
MQ | Martinique |
MR | Mauritania |
MU | Mauritius |
YT | Mayotte |
MX | Mexico |
FM | Micronesia, Federated States of |
MD | Moldova, Republic of |
MC | Monaco |
MN | Mongolia |
MS | Montserrat |
MA | Morocco |
MZ | Mozambique |
MM | Myanmar |
NA | Namibia |
NR | Nauru |
NP | Nepal |
NL | Netherlands |
AN | Netherlands Antilles |
NC | New Caledonia |
NZ | New Zealand |
NI | Nicaragua |
NE | Niger |
NG | Nigeria |
NU | Niue |
NF | Norfolk Island |
MP | Northern Mariana Islands |
NO | Norway |
OM | Oman |
PK | Pakistan |
PW | Palau |
PS | Palestinian Territory, Occupied |
PA | Panama |
PG | Papua New Guinea |
PY | Paraguay |
PE | Peru |
PH | Philippines |
PN | Pitcairn |
PL | Poland |
PT | Portugal |
PR | Puerto Rico |
QA | Qatar |
RE | Réunion |
RO | Romania |
RU | Russian Federation |
RW | Rwanda |
SH | Saint Helena |
KN | Saint Kitts and Nevis |
LC | Saint Lucia |
PM | Saint Pierre and Miquelon |
VC | Saint Vincent and the Grenadines |
WS | Samoa |
SM | San Marino |
ST | Sao Tome and Principe |
SA | Saudi Arabia |
SN | Senegal |
CS | Serbia and Montenegro |
SC | Seychelles |
SL | Sierra Leone |
SG | Singapore |
SK | Slovakia |
SI | Slovenia |
SB | Solomon Islands |
SO | Somalia |
ZA | South Africa |
GS | South Georgia and the South Sandwich Islands |
ES | Spain |
LK | Sri Lanka |
SD | Sudan |
SR | Suriname |
SJ | Svalbard and Jan Mayen |
SZ | Swaziland |
SE | Sweden |
CH | Switzerland |
SY | Syrian Arab Republic |
TW | Taiwan, Province of China |
TJ | Tajikistan |
TZ | Tanzania, United Republic of |
TH | Thailand |
TL | Timor-Leste |
TG | Togo |
TK | Tokelau |
TO | Tonga |
TT | Trinidad and Tobago |
TN | Tunisia |
TR | Turkey |
TM | Turkmenistan |
TC | Turks and Caicos Islands |
TV | Tuvalu |
UG | Uganda |
UA | Ukraine |
AE | United Arab Emirates |
GB | United Kingdom |
UY | Uruguay |
UZ | Uzbekistan |
VU | Vanuatu |
VA | Vatican City State |
VE | Venezuela |
VN | Viet Nam |
VG | Virgin Islands, British |
VI | Virgin Islands, U.S. |
WF | Wallis and Futuna |
EH | Western Sahara |
YE | Yemen |
ZM | Zambia |
ZW | Zimbabwe |
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City / State: |
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AK | Alaska |
AL | Alabama |
AR | Arkansas |
AZ | Arizona |
CA | California |
CO | Colorado |
CT | Connecticut |
DC | District of Columbua |
DE | Delaware |
FL | Florida |
GA | Georgia |
HI | Hawaii |
IA | Iowa |
ID | Idaho |
IL | Illinois |
IN | Indiana |
KS | Kansas |
KY | Kentucky |
LA | Louisiana |
MA | Massachusetts |
MD | Maryland |
ME | Maine |
MI | Michigan |
MN | Minnesota |
MO | Missouri |
MS | Mississippi |
MT | Montana |
NC | North Carolina |
ND | North Dakota |
NE | Nebraska |
NH | New Hampshire |
NJ | New Jersey |
NM | New Mexico |
NV | Nevada |
NY | New York |
OH | Ohio |
OK | Oklahoma |
OR | Oregon |
PA | Pennsylvania |
PR | Puerto Rico |
RI | Rhode Island |
SC | South Carolina |
SD | South Dakota |
TN | Tennessee |
TX | Texas |
UT | Utah |
VA | Virginia |
VI | Virgin Islands |
VT | Vermont |
WA | Washington |
WI | Wisconsin |
WV | West Virginia |
WY | Wyoming |
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User Agreement
HIPAA Privacy Agreement
By checking the box below, I certify that I have read and agree to the terms and conditions listed above. I also affirm that
I am the cardholder and have been properly informed that my card will be charged by "Careplans LLC" for the total
amount of the membership fee shown above, until the event of cancellation.
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