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MoANA Nomination Form
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* Indicates required question
Name of person completing form:
*
Your answer
Email of person completing form:
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Your answer
Cell phone of person completing form:
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Your answer
Name of Missouri CRNA Nominee:
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Your answer
Email of Missouri CRNA Nominee:
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Your answer
Cell Phone of Missouri CRNA Nominee:
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Your answer
I nominate the above Missouri CRNA for the following board positions:
*Candidate must have previously served on the board for two years.
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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
MoANA Regions
I nominate the above Missouri CRNA for the following Committees:
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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 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.
Required
Why do you feel this CRNA would make a great MoANA Board of Committee member?
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Your answer
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