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. *

Captcha

Change the CAPTCHA codeSpeak the CAPTCHA code