MoANA Board or Volunteer Interest Form

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MoANA Regions

Rotating Ballot

1-Year Term:

President
President-Elect
Vice President

2-Year Terms (Rotating ballot slots):

Treasurer (odd years)
Secretary (even years)
Region I-V Directors:

I, III, V (odd years)
II, IV (even years)

I am interested in serving MoANA in the following board positions:

* President & Vice President candidate must have previously served on the board for two years. *

President/President-Elect* (1-year term)

Vice President* (1-year term)

Treasurer (2-year term elected in odd years)

Secretary (2-year term elected in even years)

Region Director I (2-year term elected in odd years)

Region Director II (2-year term elected in even years)

Region Director III (2-year term elected in odd years)

Region Director IV (2-year term elected in even years)

Region Director V (2-year term elected in odd years)

I am not interested in any of these positions at this time.

Required

I am interested in serving MoANA in the following Committees or Chair positions:
(appointed positions; name does not go on ballot) *

Wellness Committee

Political Action Committee

Diversity, Equity, Inclusion Committee

Marketing & Communications (Public Relations) Committee

State Governmental Relations Committee

State Key Contact

Federal Governmental Relations Committee

Congressional (Federal) Key Contact

Website Committee

Education Committee

Student Involvement Committee

CRNA State Reimbursement Specialist (Billing)

Bylaws Committee

I am not interested in any of these positions at this time.

Other:

Required

I would like to help MoANA in another way:

Full Name: *

AANA Number: *

Street Address: *

City, State, Zip *

Cell Phone: *

Email Address: *

Type full name as signature *

Signature Date *

YYYY

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