Question Title

* 1. Name

Question Title

* 2. AANA Number

Question Title

* 3. Post-Nominals (CRNA, DNAP, etc.)

Question Title

* 4. Address

Question Title

* 5. Phone

Question Title

* 6. Email

Question Title

* 7. I would like to be a candidate for:

Question Title

* 8. Please list any S.C.A.N.A., AANA or AANA state affiliate board positions or committees on which you have previously served:

Question Title

* 9. Please upload your Position Statement and/or Bio here.
(You may also email to Info@SCCRNA.org within 48 hours.)

Question Title

* 10. Please upload your CV/Resume here.
(You may also email to Info@SCCRNA.org within 48 hours.)

Question Title

* 11. Please upload your Headshot here.
(You may also email to Info@SCCRNA.org within 48 hours.)

Question Title

* 12. By typing your name below, you hereby give consent to having your name, position statement, and headshot placed on the S.C.A.N.A. ballot for the above-selected position. Additonally, you agree to participate in any "meet the candidate" forums or video messaging.

T