Long-Term Care Staff Registration By registering as an individual long-term care staff member, you are showing your personal commitment to quality improvement in long-term care and to the Campaign. PLEASE NOTE: Your staff registration is separate from a long-term care organization account. An organization account requires a username/password and is used to enter project data and view progress graphs. Individual staff members can still register as staff, even if their community already has an organization account. Read more about the following: Staff Participation and Registration Organization Participation and Registration asterisk (*) indicates required field I need account access Contact Information * First Name * Last Name Organization Name * City * State [Select a State] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming * Email * You may use your personal email to stay connected with the Campaign on the go! * Re-enter Email Yes, subscribe me to the monthly Campaign newsletter. I would like the LANE (the statewide group working to improve the quality of care and quality of life for residents) to contact me about how I can help. Please give them my email address. What is a LANE? Find Local Support * I Support (choose one): One residence/site Group of residences/sites Corporate-wide *My Role(s) (check all that apply): Personal Care Medication Assistant Nursing Assistant LPN/LVN RN Admissions Coordinator Assessment Coordinator Clinical Nurse Specialist Director of Nursing Infection Preventionist Rehabilitation Therapist Quality Improvement Activities/Life Enrichment Social Worker Staff Development Nutrition, Dietary or Food Service Staff Environmental Services Staff (housekeeping, laundry, maintenance) Health Information Management/Medical Records Administrative and Support Staff Clinical Consultant (dietitian, pharmacist, etc.) MD/NP/PA Medical Director Administrator/Executive Director Other (please describe): * I want to help in the following ways (check all that apply): My nursing home has joined the Campaign and I want to help achieve selected goals. Ask my nursing home to join the Campaign and work to help achieve the selected goals. Have discussions about the Campaign at professional association and union meetings. Share information about the Campaign with resident and family councils. Learn about the goals and share this information with others. Other (please describe): By clicking the I Accept button below, I voluntarily agree to be involved in working toward the goals of the Campaign. I also understand my contact information will not be shared for marketing or other purposes not directly related to the Campaign.