Application Form for INSGNA Spring and Fall Conferences and SGNA Annual Conference

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Email *

Name *

Date *

YYYY

Degree/Title *

Present position/Title *

Address *

Phone *

Work Phone *

Employer Name *

Work Address *

Name of Supervisor *

Mail Preference (utilized for reimbursement purposes): *

Home

Work

Have you been an active member of INSGNA/SGNA for greater than or equal to a year? *

Yes

Year INSGNA/SGNA joined: *

List all INSGNA/SGNA meetings and activities you have attended in the last 3 years: *

What are your goals and objectives for attending the SGNA education course? *

I support INSGNA's goals and objectives as demonstrated by my involvement in: *

Please list any INSGNA/SGNA offices or committee positions you have held: *

I understand that if I receive an educational course scholarship, I am required to apply funds received toward tuition of that course. I agree to return to INSGNA any unused portion of the scholarship. You will be required to write an article for the newsletter or do a presentation at an INSGNA meeting within 60 days of attending the course. *

I understand

Required

Send me a copy of my responses.

Submit

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