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2027 LSNA Consent to Serve Ballot

Submit your completed Consent to Serve Ballot Statement form by January 2, 2027. Nominations must be received by January 2, 2027, by 11:59 p.m. You will be notified of the election results during the 2027 Membership Assembly.

Definition and Qualifications

1. Hold current ANA/LSNA membership.
2. Not concurrently serving in a leadership position of another professional organization in such participation might result in a conflict of interest with LSNA, as determined by the Nomination Committee or, in the case of filing a vacancy, by the Board of Directors.




1.I wish to have my name placed on the LSNA election ballot for the position of:
2.Name
3.Credentials
4.Personal E-mail Address
5.LA RN License #
6.ANA Membership #
7.Home Address , City, State, Zip Code
8.Cell Phone
9.Employer Name and Location (City)
10.Job Position
11.Do you serve in any other leadership capacity?
12.If so, what organization and position?
13.Write a narrative that will be included on the election ballot (maximum 150 words). Briefly and concisely write (in 1st person) why you want to serve. Include specific position qualifications and relevant experience related to core competencies and specific board of committee competencies.
14.Please attach your CV.
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15.Please submit your professional headshot.
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16.Please enter your name as an electronic signature.