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:*
Breakthrough to NursingBylawsCommunicationsCommunity HealthConvention and ProgramsLegislation and Political ActionMembershipNominations and ElectionsResolutionsWays and MeansPolicies
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: