National Nurses United

National Nurses United - Registered Nurse Response Network - For Haiti Medical Relief - Send Nurses Now

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Haiti RN Updates

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UNITED.org

RNRN Disaster Relief Volunteer Form

Be there for patient care...

Thank you for signing up with the NNU RN Response Network in collaboration with the CNA/NNOC. Registering as a RNRN volunteer does not automatically mean you will be called for a disaster. RNs will be asked to volunteer based on need and availability.We are currently recruiting RN volunteers to provide relief in Haiti following a major earthquake 01/12/10. PLEASE JOIN US!

Download & share the RNRN brochure

RNs complete this form to express interest in volunteering:

First name *
Last name *
Address *
City *
State/Province *
Zip/Postal Code *
Home Phone *
Cell Phone
Primary Email *
Are you a Registered Nurse?	yes no
RN License Number
Are you a Nurse Practitioner?	yes no

Hospital or Affiliation (Name and Location)

Unit/Expertise *	ER yes no
(Answer required for each)	ICU yes no
	MEDSURG yes no
	PEDS yes no
	PSYCH yes no
Unit/Expertise Other
CURRENT Specialties/Certifications *	ACLS yes no
(Answer required for each)	PALS yes no
	BLS yes no
	CCRN yes no
	PHN yes no
Other Specialties/Certifications
Job Title or Classification
Experience & Travel:
Do you have disaster relief experience? *	yes no
Do you have a current passport? *	yes no
Availability: (click the down arrow to select)
Other availability
Vaccinations:
Vaccination - Hepatitis A	yes no
Vaccination - Hepatitis B	yes no
Vaccination - Typhoid	yes no
Tetanus	yes no
You will also need Malaria Prophylaxis
Language:
Do you speak French? *	yes no
Do you speak Creole? *	yes no
What is your primary language? *
List other languages you speak?
Affiliations:
Are you a NNU member? *	yes no
Are you a CNA/NNOC member? *	yes no
Are you a member of RNRN? *	yes no
Indicates Required Fields *
Thank you! Please wait to be contacted after submitting.

Download the RNRN brochure and share it with others!

AFFILIATED ORGANIZATIONS

AFL-CIO
National Nurses United
National Nurses Organizing Committee
Massachusetts Nurses Association
Caregiver and Healthcare Employees Union
California Nurses Foundatio n
Registered Nurse Response Network (RNRN)

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