Southern Arizona Nurse Honor Guard Volunteer Application
A Google email will work best but any are accepted. Please complete all required fields below and submit your payment via PayPal or check to the treasurer. Once payment is processed, your application will be approved. Welcome to the Southern Arizona Nurse Honor Guard ~ we are glad to have you!
Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Credentials *
Birthday (Optional)
MM
/
DD
/
YYYY
Street Address *
City *
State 
Zip *
Home Phone Number *
Cell Phone Number *
Communication Preferences #1 - How to best contact you? *
1st Choice
2nd Choice
3rd Choice
4th choice
Email
Home Phone
Cell Phone
Home address
Communication Preferences #2 - Please note if we can publish your info to members or not. (Information is not sold for marketing, only used internally)
 *
Yes, I consent to share
No, please do not share
Email
Home Phone
Cell Phone
Home Address
Nursing status *
Employer/Organization (Optional)
I have read and agree to the current Southern Arizona Nurse Honor Guard bylaws as published via this link: Southern Arizona Nurse Honor Guard Bylaws *
Organizational interest *
Required

I understand that any member of this organization including elected officers, board of directors, standing committee members, non-officer nurse volunteers or student nurse volunteers shall not post the name of any deceased memorialized nurse unless we have express written permission or a written request from the family or loved ones of the deceased.

This includes, but not limited to: any and all private and public social media such as Facebook, Twitter, SnapChat, LinkedIn, and Instagram. In addition publications, journals, articles, newspapers, websites, blogs, YouTube videos, or any source of media visible to the public including friends or acquaintances of all social media and written platforms.
Upon becoming a member this disclosure form is provided and signed before attending the first meeting and/or first ceremony.
By signing this, I understand that if the name of the deceased is posted on any social media page, private or public, without written permission from the family or loved ones of the deceased, I will be asked to remove the post immediately. Should there be a second violation of this policy,  I understand the board will review the specific details and determine the course of action to be taken.
I acknowledge the following by checking the 'I Agree' box below, I am signing this document and I understand I must comply with the stated policy: 

 *
Membership status *
Method of payment

 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms