About you

Thank you for taking the time to join the CNAN.

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* 1. What is your first name?

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* 2. What is your surname?

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* 3. Which region are you based in?

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* 4. What is your main role as a community nurse?

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* 5. What is the best e-mail address to contact you on?

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* 6. If you use twitter, what is your handle?

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* 7. Have you joined the NHS Futures Nurse Ambassador Platform? If you haven't joined the NHS Futures platform, please follow the link at the end of this application to join.  Joining is part of signing up for CNAN. 

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* 8. Is there anything else you would like to tell us?

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