Delegate Form

NAME:  

DATE:  

E-Mail Address:  

HOSPITAL:  

Active participation within local chapter defined by points earned for delegate selection.

Fill in the total number of points you have earned for each activity between July 1 and June 30 of previous chapter year.

Officers in Local Chapter	Points
President	6
Vice President	4
President-elect	4
Treasurer	5
Secretary	5
Board Member	3
Committees	Points
Membership	3
Program	3
Ways and Means	3
Newsletter	3
Bylaws	2
Legislation	2
Historian	2
Continuing Education	2
Special Committees	Points
Nominating	2
Workshop and Seminar   (Chair)	4
Workshop and Seminar   (Member)	2
Other Considerations	Points
Chapter business meeting attendance	1/Meeting
CNOR	1
Participation in fund raising activities	1
Consent to run for office	1
Recruit new member	1/Member
PCORN meeting attendance	1/Meeting
Chapter workshop attendance	1/1-Day Seminar
Speaker at AORN function or related event	2
Congress attendance	5
Workshop/Seminar OR related	1/1-Day Session
PCORN committee participation	3
PCORN officer	4
National AORN officer	4
National AORN committee member	3
Participation in Service Project	1/Session

APPLICATIONS MUST BE SUBMITTED TO THE NOMINATING COMMITTEE NO LATER THAN THE OCTOBER BUSINESS MEETING.
NO APPLICATIONS WILL BE ACCEPTED AFTER THIS TIME. Your online submission will be electronically time stamped.

     

PRINT THIS FORM FOR YOUR RECORDS BEFORE PRESSING "SUBMIT" BUTTON.

Revised 08/30/2006

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