VIP Application

​VIP Application

The VIP Network offers its members an opportunity to be a part of innovative quality improvement (QI) projects that test out and implement cutting-edge best practices. 

First Name *

Last Name *

Email Address *

Phone *

Please check which boxes best describe you (Check all that apply): *

Please enter your hospital/organization name *

If you selected Sub-specialist, please enter Sub-specialty

Please describe your practice setting: *


Please indicate the number of pediatric med/surgical beds in your practice setting? *

Please indicate your experience with quality improvement. (Please check all that apply): *


Describe what you would like to accomplish by participating in VIP. This might address benefits for yourself, your staff, or your patients. *


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