Region 2 Consent to Serve Form

I am interested in participating in an elected position of the Oklahoma Nurses Association and have read the ONA Region 2 Bylaws. I consent to serve in the following position if elected by the ONA Region 2 membership.

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* I am applying for the position of

President-Elect/ONA Representative (2-year Term, 2nd year as President)

Secretary-Treasurer

Program Coordinator Elect (2-year term, 2nd year as Program Coordinator)

Directors at Large (Two Opportunities for a 2-year term)

Nominations Coordinator

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* First Name

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* Last Name

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* Home Steet Address:

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* City

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* State

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* Zip Code

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* Phone Number

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* Email

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* Credentials

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* ONA/ANA Membership

Membership Number

Exp. Date

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* Educational Preparation (school, location, degree, year)

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* Present Nursing Position (title, employer, and city)

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* Present Association Activities (ANA, ONA, DNA)

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* Other Professional and Community Activities

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* Candidates for the Board of Directors should give a statement (NOT TO EXCEED 100 WORDS) indicating your views on nursing and issues facing ONA and your position on these issues. This statement may be published in The Oklahoma Nurse.

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* Electronic Photo

Please provide a professional looking photo of yourself as a way to introduce you to region members.

PNG, JPG, JPEG file types only.

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* Electronic Signature

I consent to serve, if elected by the ONA Region 2 membership