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Name

Email

Please state the name of the country where you are currently practising as a licensed registered nurse

Please indicate your genderFemaleMaleOther - I do not identify with traditional gender descriptions

Please indicate your age groupLess than 30 years old31-40 years old41-50 years old51-60 years oldMore than 60 years old

If you are a member of a national critical care nursing association, please state the name of the association in full (or state: "not a member")

Please indicate your main area of practiceClinical practiceManagementEducationResearchOther

Please indicate the type of critical care unit in which you currently practiceGeneral intensive care unitGeneral paediatric intensive care unitCardiac intensive care unitPaediatric cardiac intensive care unitCoronary care unitAnaesthetic unitOperating room or recoveryEmergency careOther

Please indicate the type of health care setting in which you currently practisePublic or state hospitalPrivate hospitalOther

Please indicate the whether the institution in which you practise is a university or university-affiliated institutionUniversityUniversity-Affiliated Institute

Please indicate your highest academic qualificationPhDMaster's degreePost-graduate certificate or diplomaBachelor's degreeCertificate or diplomaNo academic qualification

Please indicate your highest CRITICAL CARE NURSING qualificationMaster's degree or abovePost-graduate certificate or diplomaBachelor's degreeCertificate or diplomaHospital-based courseNo critical care nursing qualificationOther

How long have you been professionally registered as a nurse?More than 20 years11-20 years6-10 years1-5 yearsLess than 1 year

How many years' experience do you have as a CRITICAL CARE NURSE?DECLARATION: I hereby declare that I am licensed professioally to practise as a nurse, and the information I have provided above is trueMore than 20 years11-20 years6-10 years1-5 yearsLess than 1 year

DECLARATIONI hereby declare that I am licensed professioally to practise as a nurse, and the information I have provided above is true

Country of Practice

Length of membershipLOW RESOURCE COUNTRIES: 4 years ($ 40)LOW RESOURCE COUNTRIES: lifetime ($ 80)MIDDLE RESOURCE COUNTRIES: 4 years ($ 80)MIDDLE RESOURCE COUNTRIES: lifetime ($ 160)HIGH RESOURCE COUNTRIES: 4 years ($ 160)HIGH RESOURCE COUNTRIES: lifetime ($ 320)

I am licensed professionally to practise as a registered nurse in the country stated in question 4YesNo

The answers I have provided to all of the questions in this application are trueYesNo

About WFCCN

The World Federation of Critical Care Nurses is a volunteer organisation providing resources for Critical Care, Cardiac Care, Respiratory Care, Disaster Management, Directory, Events and Conferences, with representatives in 37 countries across the world.

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