FOR: Presenters | Students | Candidates

2006 Interest Form For Appointed Positions

Please indicate your interest in serving on one or more of WIN’s standing and/or special committees. This information will be used by the Board of Governors when it makes appointments to committees.

If you'd rather submit your application by hardcopy, print and complete this form, and mail to the address at the bottom.

Please note: ALL FIELDS in this section are required.

Name:
Credentials:
Title:
Employer:
Address:
City:
State:
Zip:
Phone:
FAX:
Email:

I am interested in serving on the following committee(s):

Standing Committees

Bylaws
Development
Membership
Program (If you are interested in serving on the Program Committee, please indicate your area of research, education, practice/specialty)

Special Committees

Poster Awards
Silent Auction
Anna Shannon Mentorship Award Selection Committee
Jo Eleanor Elliott Leadership Award Selection Committee
Biological Nursing Research Award Selection Committee
Regional Geriatric Nursing Research Award Selection Committee