Mitigating the Madness Workshop #3 Registration Form

Our Mitigating the Madness EBP Workshop series is a hybrid workshop of online presentations followed by a 4-hour in-person session.

This hands-on session requires you to have a topic and/or project outcomes to write an abstract, and/ or manuscript, design a poster and refine your presentation skills. Enter your topic information and choose the date of the session you want to participate in and we'll send you the information to access the online presentations. After you have completed all of the activities, you will receive 7+ hours of CE.

Date of Request*

First Name*

Last Name*

Duke email address*

Please select your work title within the drop down list:*

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If other, please describe:

Please select your highest degree from the drop down list:*

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List career ladder and certification designations:*

Unit/Clinic*

Identify your work unit or clinic:

Facility*

Please select from the drop down list:

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Mitigating the Madness Workshop*

Confirm the workshop you are attending from the drop down list:

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Date Preference*

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Project Description*

Please describe the project that you want to disseminate through conference presentation or publication

What method of dissemination are you most interested in?*

Choose the appropriate answer from the drop down list:

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Topic and/or Project*

Describe what you would like to work on with your coach in this workshop. Be sure to be descriptive about the topic or project you want to disseminate.

Nurse Manager Project Approval

Does your nurse manager/supervisor know about your project and approve of your participation in this workshop? If yes, check this box.

Nurse Manager Name*

Provide your nurse manager/supervisor's name:

Provide your nurse manager's email address:*

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