House of Delegates Registration Form
Complete your delegate details, NSNA membership info, and required confirmations to register for MASN 2026.
Delegate Information
First Name
*
Last Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School/Chapter Name
*
Expected Graduation Month & Year
*
-
Month
-
Day
Year
Date
NSNA Membership Information
NSNA Membership Number
*
NSNA Membership Expiration Date
*
-
Month
-
Day
Year
Date
Dietary Accommodations
Do you have any dietary restrictions or food allergies?
None
Vegetarian
Vegan
Gluten-Free
Food Allergy
Other
Other: ____________
Delegate Expectations
Acknowledgments
*
Attend Delegate Credentialing
Attend the House of Delegates Meeting
Attend the Meet the Candidates Session
Participate in the election process
Represent my school and MASN in a professional manner
Maintain an active NSNA membership throughout the convention
Electronic Signature
Student Delegate Electronic Signature
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Faculty Advisor Verification
Faculty Advisor Name
*
First Name
Middle Name
Last Name
Faculty Advisor Email Address
*
example@example.com
Dean/Program Director Verification
Dean/Program Director Name
*
First Name
Middle Name
Last Name
Dean/Program Director Email Address
*
example@example.com
Certification
Certification Statement
*
I certify that all information provided is accurate.
I understand that my delegate credentials will be verified by MASN before I am eligible to vote.
Acknowledgment Signature
*
Submit
Submit
Should be Empty: