TANA Intent to Serve 2025-2026

Intent to Serve and Consent Form

Tennessee Association of Nurse Anesthetists 2026-2027
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
This District Director position will be to serve the remainder of the 2026-2027 term that will begin in November 2026 and ending in October 2027. If you are running for District Director, you must reside or work in your district.
I would like to be a candidate for:*

President-ElectDistrict I Director (Serving: Fayette, Shelby, Tipton)District III Director (Serving: Bedford, Cannon, Cheatham, Clay, Davidson, Dekalb, Dickson, Giles, Hickman, Houston, Humphreys, Jackson, Lawrence, Lewis, Macon, Marshall, Maury, Montgomery, Putnam, Robertson, Rutherford, Smith, Stewart, Sumner, Trousdale, White, Williamson, Wilson)District V Director (Serving Anderson, Blount, Campbell, Claiborne, Cocke, Cumberland, Fentress, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Overton, Pickett, Roane, Scott, Sevier, Union)
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
Cancelof
I hereby give my consent to have my name placed on a Ballot for the above-selected office.*

Clear
Date *

MonthDayYear
TANA Leadership Identification Committee

P.O. Box 60128, Nashville, TN 37206

Email: info@tncrna.com
Should be Empty:

Intent to Serve and Consent Form