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What is your employment setting? Please check all that apply and specify your employer/business name below Interlake-Eastern RHA Winnipeg Regional Health Authority Prairie Mountain Health First Nations and Inuit Health Branch First Nations led health clinic (specify below) Canadian Forces Health Services Centre Post-secondary education health clinic Travel nursing (specify below) Private practice (specify below) Self-employed Southern Health/Sante Sud Northern Regional Health Authority Non-RHA (specify below) Ongomiizwin Health Services (OHS) Correctional Health Services/Penitentiary Secondary education (K-12) health clinic Post-secondary education (NP educator) Virtual Care (specify below) Contract work (specify below) Other (specify below)

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What are your NP role(s) or practice site(s)? Please check all that apply Primary care Remote communities Pediatrics/neonatal Mental health Hospital care Aesthetics Locum coverage/travel Education Leadership role Urgent/emergency care Older adults/long-term care Maternity Addictions Outpatient care Private practice Virtual care Research RAAM Clinic Other (specify below)

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Are you a member of ARNM? Yes No

Are you a member of MNU? Yes No

How are you purchasing your CNPS liability insurance? Through CNPS directly Link on the NPAM website/registration page Link on the ARNM website Link on another website (ie. different association)

In your primary role as NP, what size of community does your clinic/workplace serve? Under 10,000 Under 99,999 Over 100,000 Unknown/not sure

How many NP registrations do you hold in Canada, and in what jurisdictions?

What NP program are you completing or did you graduate from? University of Manitoba Athabasca University University of Saskatchewan University of Regina Other (please specify)

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What year did you graduate/anticipate graduate as a NP?

How many years have you been practicing as a NP?

How many years did you practice as a RN before becoming an NP?

Would you be willing to volunteer for NPAM on one of the following committees? (Please select any you may be interested in) Conference Committee Continuing Education NP Day Membership & Member Benefits NPAM Awards Committee

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