We want to honor those nurses we've lost, please complete the form including the cause of death.  While all of these nurses are important, we want to make sure we know, which nurses were lost due to COVID-19.

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* 1. First Name of Deceased

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* 2. Last Name of Deceased 

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* 3. City

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* 4. State

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* 5. Date of Death

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* 6. Age

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* 7. Employer if still employed

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* 8. Cause of Death if known

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* 9. Link to article or obituary or you may upload it in the next question.

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* 10. Upload your article here if available

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