Last Call for Nominations!

Remember we are having elections in the next couple of weeks for state level UAPRN Board of Directors! Open positions are President, Vice President, and Secretary. Please fill out the consent to serve form below and email uaprnexec@gmail.com. Excited about the upcoming year!

UNITED ADVANCE PRACTICE REGISTERED NURSE
CONSENT TO SERVE FORM

VOLUNTEER PROFILE

INSTRUCTIONS: Please fill out this form and submit to the Nominating Committee. The purpose of this form is to give the Nominating Committee information concerning your desire to volunteer for state positions.
1. Volunteer's full name with no more than 4 credentials listed:
. _____________________________________________

1. Volunteer Positions of Interest:

STATE LEVEL OFFICER POSITIONS
____ President
____ Vice President
____ Secretary
____ Chair of Nominating Committee

STATE LEVEL COMMITTEES
_____Bylaws/Policy Responsible for the review/revision of association bylaws & policies.
Meetings scheduled as needed.
____ Nominating Committee

AD HOC COMMITTEES
_____Legislation & Public Policy
Assist the Director At Large
- To help monitor current legislative policy and concerns
- Meetings are scheduled as needed
_____ UAPRN Service Project Day
Meetings scheduled as needed
_____ Scholarship Committee

1. Other volunteer interests:____________________________________________________________
2. Contact Information: Cell Phone: ___________________ Email(s): ____________________________
   Home Address, City, State, Zip: ________________________________________________________
   5. Current Full UAPRN membership Number:_________________________________
   6. Major clinical, teaching, practice or research area:_____________________________________
   7. Education: (Enter highest degree earned) ___________________________________________________
   8. Current Employer: ____________________ Current title/position: ___________________________
   9. Have you ever served at the UAPRN state level? • Yes • No
   If yes, please list office and years served: _____________________________________________________
   _________________________________________________________________________________
   10. Have you served at the Chapter level? • Yes • No
   If yes, please list office and years served: _____________________________________________________
   _________________________________________________________________________________
   11. Have you served in other associations (e.g., specialty nursing organizations, state or national
   associations) • Yes • No
   If yes, please list office and years served: __________________________________________

 ___________________________                                      _______________________                Name                                                                             Date