West Virginia Nurse Newsletter

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Click here - Vol. 14, Number 1

 

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Nurse Legislative Leader Application

 

Name:
Education (check all that apply): ADN
BSN
MSN
Post-Graduate Certificate
Doctorate
Or, other education:
Certifications:
Practice Area: Hospital
Private Practice
School
Physicians Office
Education
Telehealth
Public Health
County of Residence:
Address:
City:
State:
ZIP:
Phone:
Email:
Do you have any current relationships with specific legislators in your district? If so, who?
Have you participated as a Nurse Legislative Leader in the Past? Yes
No
Are you a member of another professional organization? If so, please list all memberships.
What nursing practice issues are currently concerning you?
Current Membership in WVNA? Yes
No
Are you a member in another WVNA Congress? If so, which one?
What is your preference for the educational session? Charleston
Morgantown
To prove you're human,
what is two plus two?