Regional Officer Commitment Form - Kansas State Nurses Association

How Can I Serve?

Getting Involved in KSNA Regions

There are a number of ways to become active in the Kansas State Nurses Association. Being a Regional Officer is one of the most important, as you will help the Association stay active in your area. If you are interested in serving, please print the consent form below and return it to the KSNA office for processing.

APPLY NOW!

All participating leaders must complete this form to run for an elected position within the Kansas State Nurses Association (KSNA). Candidates must be a current KSNA member in good standing to run for office (any other specific requirements will be listed in the position description). Submission of this form indicates that you understand the duties and responsibilities of the office for which you are submitting your name. If elected, you agree to fulfill the duties of the office to the best of your ability.

I Agree To Submit My Name As A Candidate For The Office Of: *

Regional President

Regional Vice President

Secretary/Treasurer (Elected in odd years for a two year term beginning Jan 1 of the next year)

Member-at-Large (Elected in even years for a two year term beginning Jan 1 of the next year)

First Name: *

Last Name: *

Credentials: *

Street: *

City: *

State: *

Zip Code: *

Phone/Mobile: *

Email Address: *

Qualifications - For Possible Nominations Committee Review: *

Position Statement - For KSNA Members To Review: *

By submitting this form, I am committing to:

Provide leadership in line with KSNA’s Vision and Mission;
Be accountable to KSNA members – communicate honestly and transparently; and,
Fulfill the duties of the position and participate when requested.