Please complete these questions. First and Last Name Company Name Phone Number Email Address Street Address City Zip Code *I hereby grant permission to Hmong Nurses Association to take photos and video with sound recordings to use the photographic or electronic reproduction of me in publications, news releases, online platforms including Hmong Nurses Association’s Facebook page and website, and in other communications and public relations outlets as it is applicable to the mission of Hmong Nurses Association. *I hereby grant permission to Hmong Nurses Association to take photos and video with sound recordings to use the photographic or electronic reproduction of me in publications, news releases, online platforms including Hmong Nurses Association’s Facebook page and website, and in other communications and public relations outlets as it is applicable to the mission of Hmong Nurses Association. Yes, I agree No, I disagree Register Our Sponsors