MAR - 2019 Consent to Serve

Navigation

Submission form is not working at this time.

For assistance, please Email: webmaster@marwocn.org and we will forward it to the proper person.

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?