Are you a member of the NJENA Jersey Shore Chapter? *
Are you an currently active member of NJENA at the state or chapter level? *
Do you hold one of the following officer positions at the chapter level? *
Have you attended 50% of the NJENA State Council meetings in the last year? *
Have you attended 50% of the Chapter meetings in the last year? *
Have you served in an elected position at the Local, State, or National level during the past three years? If so, please specify. *
Your answer
Have you served in an appointed position at the Local, State, or National level during the past three years? If so, please specify. *
Your answer
Have you participated in at least one (1) of the following activities related to emergency nursing since the previous General Assembly: (list what you did) *
Required
Please explain above answer by listing what you have done
Your answer
Are you interested in being mentored as a delegate?
Clear selection
I verify that the above information is correct. I understand the roles and responsibilities of a delegate and/or alternate in ENA General Assembly. Failure to comply with the above responsibilities will affect eligibility for reimbursement. *
Required
A copy of your responses will be emailed to the address you provided.