Answer Sheet

Self-Care as a Nurse’s right and responsibility

Note: The 1.0 CH and 0.1 CEU for this program will be offered until June 1, 2026.

Please print legibly and verify that all information is correct.

First Name: MI: Last Name:

Street Address: City: State: ZIP Code:

Daytime Phone Number (Include area code):

Email:

Profession: Currently Licensed in NY State? Y / N (Circle one)

NYSNA Member # (if applicable): License #: License State:

ACTIVITY FEE: Free for NYSNA members/$10 nonmembers

PAYMENT METHOD

Check—payable to New York State Nurses Association (please include “Journal CE” on your check).

Credit Card: Mastercard Visa Discover American Express

Card Number: Expiration Date: / CVV#

Name: Signature: Date: / /

Please print your answers in the spaces provided below. There is only one answer for each question.

Please complete the answer sheet above and course evaluation form on reverse. Submit both the answer sheet and course evaluation form along with the activity fee for processing. Email to: journal@nysna.org

Or Mail to: NYSNA, attn. Nursing Education and Practice Dept. 131 West 33rd Street, 4th Floor, New York, NY 10001 Or fax to: 212-785-0429

Journal of the New York State Nurses Association, Vol. 50, No. 1