Austin Area AORN

Willingness to Serve Form

Delegate/Alternate Delegate to 2004 National Congress

 

 

Following our chapter bylaws, voting for Chapter delegates to Congress will be completed during the October Chapter meeting.  One delegate will be the Chapter President.  In addition, the Chapter will fund _ delegates and one (1) alternate to the 2004 National Congress.  (FYI:  National has not yet sent official delegate calculations for delegates…last year was 5 with membership of 166.  Our membership on end of June was 156, but calculations are based on a formula which should be available by August meeting.

 

To be eligible to serve as delegate/alternate, a nominee must have met all of the following criteria:

            _____Current membership status inChapter
          _____Attended at least six chapter meetings in the last 12 months
          _____Served on at least one (1) committee
                                      OR
          _____Participated in workshop or fundraising activity in the past 12 months (excluding attendance)

 

If you meet the criteria and are interested in serving as a delegate/alternate to AORN National Congress 2004, please complete this form and return to any Chapter officer to be forwarded to a member of the nominating committee:  Freth Carroll, Marilyn Saathoff or Linda Diebel.

 

          _____I am aware of the responsibilities of serving as delegate/alternate as outlined in the Chapter policies.

 

 

Please print Name _____________________________________________________________________

 

Home Phone_______________________________ Work Phone ________________________________

 

 

            ________________________________________________           ______________________

                                    Signature                                                                                  Date

           

           

This Willingness to Serve Form must be received by the Nominating Committee by September 10th.

 

Chair:  Freth Carroll                                                      email: frethcarroll@juno.com

1266 E. Lone Star Dr.                                      home phone:  512-396-8199

Buda, TX  78610

 

If you have questions regarding meeting attendance, contact Freth Carroll, the Nominating Committee Chair.

 

 

           



           

Nomination(s) for Perioperative Nurse of the Year 2003-2004: ________________________________________________________________________

 

Nomination(s) for 1st Time Congress Award Recipient: ______________________________________________________________________________