Application - 2010 eChapter Delegate

Personal Information

Name: E-mail: Cell Phone (for delegate roster at Congress): AORN Membership Number

Selections

You cannot SUBMIT until all questions in RED have been answered. Priority is given to those who have participated in eChapter; please list your activities.

Is eChapter your PRIMARY chapter? No    Yes    Is this your first AORN Congress? No    Yes    Have you every been a delegate? No    Yes    If yes,have you ever been an eChapter delegate? No    Yes    Are you new to eChapter? No    Yes    List ways in which you have participated in eChapter (one activity per line) Would you be willing to run for eChapter office? No    Yes    Would you participate on an eChapter committee? No    Yes