Application to Serve on a State Committee

Application to Serve on a State Committee
State Committees work with the executive board throughout the year in the planning and implementation of various projects and activities.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NSNA Membership ID
School of Nursing
Graduation Date
Have you served as a delegate?
School or State Offices Held:
List any conferences or conventions attended:
Please click on the committees that interest you. Completed forms should be submitted to the FNSA President by the last day of convention (Friday) or at a subsequent Executive Board meeting.
If you are interested in one or more committees, please list them below and indicate your order of preference.
Please verify that you are human
Should be Empty: