NAHN Intent To Run Form 2019

Dear NAHN member – Thanks so much for your recent participation in the NAHN Nominating Committee webinar and for taking the next step to becoming a candidate for office.
Please prepare a photograph that you’d like to use for our candidate announcement. Staff will be following up with all candidates who complete the intention to run form to request your photograph.

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* 1. Personal contact information of nominee.

Name *

Chapter *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Provide the following information about your employer.

Employer Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Work Email Address *

Work Phone Number *

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* 3. Additional nominee information.

Credentials

RN/LPN/LVN License #

NAHN Chapter

Position/Title

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* 4. Please indicate the position you are seeking. (Only one position per submission).

Treasurer

Secretary

Board Member Two-Year Position (three positions)

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* 5. Please describe your NAHN experience and other qualifications for seeking this office.

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* 6. Please provide your platform statement (150 words maximum)

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* 7. By entering your name as a digital signature in the space provided below you are confirming that you are a current member of NAHN and that the information you provided is true and up to date.