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Nomination Form For NIAA Elections
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* Indicates required question
Date
*
Your answer
Nominator Information
Nominator Name
*
Your answer
Regulatory Registration (RN, NP, RPN, LPN) OR AAN registration for graduate-level nursing students
*
Active registration is required for being a nominator
Your answer
Nominator Email
*
Your answer
Nominee Information
Must be a nurse with active registration with their regulatory body or a graduate nursing student with AAN.
Nominee Name
*
Your answer
Address
*
Address, City, Postal Code
Your answer
Phone
*
Your answer
Email
*
Your answer
Nominee for Position of
*
President
Vice President
Treasurer
Secretary & Member Services
Public Relations/Website Manager
Education Coordinator
CNIA Alberta Jurisdictional Representative
Background Information
Highest Level of Education
*
College
BSc
Master's
PhD
Graduate-level student in an accredited Alberta nursing program
Work Experience
Employment Location (i.e., Province)
Your answer
Job Title
Your answer
Declaration
(please fill out only if you are self-nominating)
I have read the particulars of NIAA's bylaws and constitution. I understand the commitment in time and contribution I will be expected to make.
I hereby accept the nomination and responsibilities that accompany the position I have been nominated for and accept all the terms and conditions. I hereby declare that all the information disclosed is true and correct to the best of my knowledge
Yes/No
Please type Yes to accept
Your answer
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