Wednesday, July 30, 2025
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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! *