Online Consent Form

Thank you for your interest in serving WSNA at the state level! We are confident you will find this to be personally and professionally rewarding. Before completing this form, please refer to Volunteer Expectations in WSNA's Handbook for Board, Cabinet, council & Committee Members and review the expectations for participation on a board, cabinet, council or committee at WSNA. then, please turn to the Volunteer Opportunities section and think about how you would like to serve your state nurses' association.

Once you have decided, complete and submit the Consent to Serve form which follows or use the link to print a copy of the form that can be filled out and mailed to WSNA, 575 Andover Park West, Suite 101, Seattle, WA 98188.  If possible, include a head and shoulders photo if you do not have one currently on file in the office.

This electronic form is set up so you are not required to fill it out in a single session, although that is the preferred option.  Each set of responses is saved when you press the "next" or "done" buttons.  If your connection times out you can go back in and pick up from the last saved section.

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* 1. Acknowledgement - By submitting this Consent to Serve form I am consenting to be appointed or elected to the positions specified on pages 3 and/or 4 of this form, and if seated will fulfill the volunteer expectations as described in WSNA's Handbook for Board, Cabinet, Council & Committee Members.  I submit my initials as proof I have read and agree to this statement.

  • All wishing to be considered for election or appointment, please complete pages 1 and 2 and enter your full name in lieu of written signature at the bottom of page 4.
  • If seeking a cabinet, council, or committee appointment, also complete page 3.
  • If seeking elective office, then also complete page 4

Note:
  • All positions are unpaid and follow WSNA's expense reimbursement policy.
  • All positions are for two-year terms unless otherwise noted.
  • Proficiency with use of email is recommended since most business outside of meetings is done electronically.

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* 2. Please provide your contact information:

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* 3. Additional contact information

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* 4. Nursing Preparation: Please state your highest nursing degree and non-nursing education.  Enter name of school for each applicable option.

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* 5. Professional experience

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* 6. Prior professional work experience

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