Register New Account // ENA Lantern Award Application

Register a New Emergency Department for a Lantern Award Application Account

All information below is required.

Emergency Department

Name of Emergency Department:
Hospital Affiliation:
Street Address 1:
Street Address 2:	(Not Required)
City:
U.S. State:
U.S. Postal Zip Code:

Chief Nursing Officer (CNO)

Name / Credentials:
Title:
Work E-mail Address:
Phone Number:	Format telephone numbers as 123-456-7890.
Fax Number:	(Not Required) Format telephone numbers as 123-456-7890.

Primary Contact

Please provide the following information for a primary contact at your emergency department.

This person has overall responsibility for the application and should be able to answer clarifying questions after the application is submitted. In addition, this person will receive notifications from ENA, including the outcome of your application review. It is recommended that this person be the emergency department manager or director.

Name / Credentials:
Title:
Work E-mail Address:
Phone Number	Format telephone numbers as 123-456-7890.
Fax Number	(Not Required) Format telephone numbers as 123-456-7890.

Account Administrator

Please provide the work e-mail address for an account administrator for the application.

This person has primary responsibility for completing and submitting the application. The account administrator can be anyone in your organization, including the same person listed as the Primary Contact.

Work E-mail Address

Application Login

Please provide the following information to create a common password for all individuals listed above (CNO, Primary Contact, and Account Administrator). Each will use their work e-mail address and the password you enter below to access the Lantern application. Be sure to copy and save this information so it can be accessed later if the password is forgotten. In addition, make sure to provide the password and security question answer to the CNO, Primary Contact and Account Administrator.

Password:	Passwords are required to be a minimum of 6 characters in length with at least 2 special characters. Example: P@s$w0rd
Confirm Password
Security Question:	Type a question that will be used for password retrieval in case you forget your password.
Security Question Answer: