Tuesday, March 3, 2026
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  The Nurses Magazine Trailblazer Award Form

If you are interested, please fill out the form below:

    Name * Credentials Email * Phone * Nominee Type *
    Nominee's Full Name * Credentials Nominee's Email * Nominee's Phone Number * Nominee's Mailing Address * Instagram Handle Facebook Profile Link LinkedIn Profile Link
    Nominee's Mailing Address * Instagram Handle Facebook Profile Link LinkedIn Profile Link
    Upload a Professional Photo * Upload Supporting Document (CV, awards, publications, etc.) Tell us why you or the nominee should be recognized for the Trailblazer Award! *