[Imported] Iowa Nurses Association 2025 Leadership Elections

Iowa Nurses Association 2025 Leadership Elections - CONSENT TO SERVE

CONSENT TO SERVE
1. First Name*
2. Last Name*
3. Credentials*
4. Email *
5. Cell Phone*
6. INA Member in Good Standing?*

YesNo
7. Current (or most recent) Nursing Position*
8. Current (or most recent) Employer*
9. Education (highest level and school)*
10. Iowa RN License Number*
11. Address*
12. Address 2
13. City*
14. State*
15. Zip Code*
16. In which INA region do you reside?*

CentralNortheastNorthwestSoutheastSouthwest
Click on the links below for the position description to respond to question #17:
17. I consent to have my name considered on the ballot for (select all you are interested in)*

President-ElectAt-Large Director (2)Newly Licensed DirectorANA Membership Assembly RepresentativeNominations Committee (2)Iowa Nurses Foundation (2)Region Secretary / Treasurer: CentralRegion Secretary / Treasurer: SouthwestRegion Secretary / Treasurer: SoutheastRegion Secretary / Treasurer: NortheastRegion Secretary / Treasurer: NorthwestRegion Board Liaison: NorthwestRegion Board Liaison: NortheastRegion Board Liaison: CentralRegion Board Liaison: SouthwestRegion Board Liaison: SoutheastRegion President: NorthwestRegion President: NortheastRegion President: CentralRegion President: SouthwestRegion President: Southeast
18. What activities are you currently involved with or have been with in the past related to INA or ANA? *

0/2500
19. What other professional organizations are you involved with? *

0/2500
20. What other elected, appointed offices or community activities relevant to this position have you been involved with? *

0/2500
21. Indicate why you want to serve in this role(s) and why you are best qualified to carry out the duties of this office. This statement will be shared publicly with the membership. *

0/10000
22. Please upload a professional headshot or high-resolution photo of yourself. Head and shoulders only are preferred. Photos will only be used for the Leadership Elections Slate of Candidates.*

Cancelof
23. Please upload your current resume (PDF preferred).*

Cancelof
24. By submitting this Consent to Serve form, you agree to attend all meetings and contribute to leadership initiatives and goals as identified by the INA Board of Directors and Bylaws.*
Should be Empty:

Iowa Nurses Association 2025 Leadership Elections - CONSENT TO SERVE