2026 Delegate Form General Assembly

2026 Delegate Form General Assembly
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Hospital*
Please answer the questions below with your appropriate information

*** Please select the highest level that applies (ie-TNCC faculty not provider, instructor and director) Some categories are assigned higher than others- please upload your certificates at the end
Points will automatically calculate

First Time Delegate1-5 years as RN6-10 years as RN11-15 years as RN15-20 years as RN20+ years as RN1 years as ENA member2-5 years as ENA member6-10 years as ENA member11-15 years as ENA member15 + years as ENA memberTNCC providerTNCC instructorTNCC directorTNCC facultyENPC providerENPC instructorENPC directorENPC facultyTNAC providerTNAC instructorCENTCRNCPENCTRNCFRNCBRNCCRNAttended State Meeting April 29th, 2025Attended State Meeting Sept 6th, 2025Attended State Meeting Nov 15th, 2025Attended State Meeting Feb 17th, 2026Attended Leadership 2026 ConferenceAttended New Orleans 2025 ConferenceAttended Lansing 2025 ConferenceMENA Board of Directors 2025/ 2026Chair a National Committee 2025/2026Chair a State Committee 2025/2026Serve on a National Committee 2025/2026Serve on a State Committee 2025/2026Speaker at any conference in 2025/2026Poster presentation in 2025/2026Volunteer for a community event 2025/2026Provide additional educational opportunity to coworkersProvide additional educational opportunity to publicWork contingent in an ERWork part time in an ERWork full- time in an ERBedside RN
Total Points*
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I have been truthful on my application and uploaded all my required documents*

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2026 Delegate Form General Assembly

Please answer the questions below with your appropriate information