Educational Conference
NEW FACULTY APPLICATION
NATCO has several educational conferences throughout the year. Experienced members are utilized to share their expertise as faculty members. Any NATCO member who is interested in becoming an educational conference faculty member for any of the meetings should complete this application and mail/email it to the NATCO Executive Office with a copy of his/her CV or resumé.
Submission date:
Name:
Title:
*Certifications (for Introductory Course and Review Courses, applicants must be CPTC or CCTC):
*Not required for Hospital Development, Family Support or sessions presented by MDs.
Organization Name:
Organization Address:
City/State/Zip:
Daytime Phone:
Email:
The meeting at which I would like to present is:
Transplant
Annual Meeting (late July/early August of each year)
Introductory Education Course (June of each year)
CCTC Review Course
Procurement
Annual Meeting (late July/early August of each year)
Introductory Education Course (June of each year)
CPTC Review Course
Advanced Hospital Development Course
Organ Preservation Symposium
How long have you been employed in the transplant/procurement field?
Are you a current member of NATCO? Yes No
Are you or have you served on any NATCO committees? If so, please describe:
My prmary Area of Practice is:
Transplant:
Administration (Administration only, no patient care duties)
Clinical Nurse Manger (Administration and direct patient care duties)
Pediatrics Staff Nurse
Adult Nurse Practitioner Adult Nurse Practitioner
Acute Care Nurse Practitioner Pediatric Nurse Practitioner
Family Nurse Practitioner Physician Assistant
Acute Care Nurse Practitioner Family Nurse Practitioner
Physician Assistant Pediatric Nurse Practitioner
Family Nurse Practitioner Physician Assistant
Pharmacy Dietetics
Social Services Case Management
Clinical In-Patient Intensive Care
General Nursing Unit Transplant Unit
Clinical Out-Patient Living Donation
Pre-Transplant Unit (Please indicate specific organs below)
Post-Transplant Unit (Please indicate organs below)
Procurement:
Upper Management (Includes CEO/ED/CFO/COO/President
Director
Public Education
Professional Education
Hospital Development
Family Care/Consent
Organ Recovery
Eye/Tissue Recovery
Preservation/Perfusion
If you work in the transplant center setting, with which organ do you work?
Heart Pancreas
Lung Liver
Islet CelL Kidney
Intestine
How long have you worked in the previously selected specialty?
Have you taught this specialty before? YesNo
If so, briefly describe:
If not, have you taught before? Yes No
If so, briefly describe:
Please return this application to:
NATCO Executive Office
PO Box 711233
Oak Hill, Virginia
(703) 483-9820
Email:
(Include a copy of your CV or resumé)