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Meet FASTAFF

If you would like to meet with a FASTAFF representative during one of our tradeshows or attend one of our monthly Open Houses to learn more about FASTAFF, please complete the form below. FASTAFF will keep this basic personal information confidential. We will use it only to contact you about your interest in our company. The fields marked with a red asterisk (*) are required.



* Are you a Nurse or a Healthcare Facility?  
 
* First MI * Last Name

 

 
* Mailing Address Apt/Suite  

  		 
* City * State * Zip code

 
 
 
* Current phone Work phone


Mobile phone Fax number


 
* Email address    

 
* How do you prefer to be contacted?
* What is the best time of day to reach you?
*   How did you find out about us?

If Other Source, please specify:
 
Nurse Information (only complete if you are a nursing professional)
 
What is your primary area of Specialty:
If Other, please specify:
 
What state license(s) do you currently hold?(e.g.: CA, NY, WA, FL, etc.)
   Select multiple states by pressing Ctrl and clicking.
 
Facility Information (only complete if you are a healthcare facility)
 
Is your facility part of a healthcare network?
 
When do you anticipate needing help with your staffing requirements?
If Other, please specify:
 
Approximately how many travel nurses will you need?
 
 
* At what event are you interested in meeting a FASTAFF representative?
 
If you are interested in attending one of our monthly Corporate Open Houses held the third Thursday of each month, which month’s Open House will you be attending?
 
Open Comments:
 
Please verify to make sure this information is correct before submitting.
     

   
    
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