MAR - 2019 Consent to Serve

Navigation

2019 Candidate Profile / Consent to Serve Form

Nominations are due by: July 31, 2019

Entries below will be used to create your candidate profile

Fields with an asterisk (*) are required

*Email Address

*Confirm Email

*First Name

*Last Name

*Address

*City/ST/Zip

*Phone (main)

Type: Home Work Cell

Phone (other)

Type: Home Work Cell

*Best time to call

*Office you are seeking

*Current Employer

Employer Location

Title/Position

Major area of responsibility

*WOCN Member?

ID# Year Joined

*Education
Enter education summary

Experience
(non WOC nursing)

Past Participation in WOCN organizations

Regional:

National:

*Position
Statement

*Consent

By checking this box, I confirm that I understand the duties and responsibilities of the office for which I am submitting my name. If elected, I agree to fulfill the duties of the office to the best of my ability.

Print?

If form does not submit, scroll up to fix any errors

upon submission you will be taken to a confirmation page