TANA Intent to Serve 2023-2024

Intent to Serve and Consent Form

Tennessee Association of Nurse Anesthetists 2023-2024
Full Name*

First NameLast Name
Credentials*
AANA Member ID*
Phone Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
President Elect, Secretary/Treasurer, and Nomination Committee Members serve a one-year commitment starting in October 2023 and ending in October 2024.

District Directors serve a two-year commitment starting in October 2023 and ending in October 2025. If you are running for District Director, you must reside in your district.
I would like to be a candidate for:*

President Elect: In order to run for this office, the candidate must have served one complete elected term previously in any board position.Secretary/Treasurer: In order to run for this office, the candidate must have served one complete elected term previously in any board position.District II Director (Jackson Area)District IV Director (Chattanooga Area)District VI Director (Northeast TN Area)Leadership Identification Committee Members: Three members are needed.
Position Statement highlighting how your experiences and knowledge will benefit TANA and CRNA practice in Tennessee:*
Current Employment*
Anesthesia School*
DNP or DNAP School (if applicable)
List any state or national committee(s) on which you have served or your most important experiences you will bring to this office. Please include dates of service or terms.*
Curriculum Vitae*

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Headshot

Headshot can be in color or black and white
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I hereby give my consent to have my name placed on the TANA Ballot for the above-selected office.*

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Date *

MonthDayYear
TANA Nominating Committee

P.O. Box 60128, Nashville, TN 37206

Email: info@tncrna.com
Should be Empty:

Intent to Serve and Consent Form