The Institute for Johns Hopkins Nursing



Biographical Data Form

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|Planning Committee | | |

|Faculty/Presenter | | |

|Name: |      |

| |First Last Degrees Credentials |

|Address: |      |

| |      |

| |      |

|Telephone: |Business:       |Fax:       |

|Email: |      | |

|Present Position: |      |

|Agency/Program/Facility: |      |

|Planners: Describe your familiarity with the target audience and experience in planning education activities. |

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|n/a |

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|Faculty/Presenters: Describe your expertise in this topic and as a presenter. |

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Use the back of this form if necessary, but DO NOT ATTACH ANY ADDITIONAL MATERIAL.

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