http://www.papanonline.org PAPAN

PENNSYLVANIA ASSOCIATION OF PERIANESTHESIA NURSES
WILLING TO SERVE FORM AND CURRICULUM VITAE

I, _____________________________________ agree to have my name placed on the ballot for the office of
_______________________________________ of PAPAN. I understand these are two year terms.
Signature ____________________________________________________________________________________
PAPAN Membership Number ____________________________________________________________________
License Number _______________________________________________________________________________
Date ________________________________________________________________________________________

Note: If the office of Vice-President is involved, I understand there is an automatic advancement to the Office of President and Immediate Past President. This commitment is a six years.
____________________________________________________________________________________________

Curriculum Vitae
Position applied for ____________________________________________________________________________
Name _______________________________________________________________________________________
Address/Phone ________________________________________________________________________________
Place of Employment ___________________________________________________________________________
Current Position held ___________________________________________________________________________
Number of years in current position ________________________________________________________________
Number of years PACU experience ________________________________________________________________
PAPAN activities ______________________________________________________________________________
______________________________________________________________________________
Number of years ASPAN Membership _____________________________________________________________
ASPAN activities ______________________________________________________________________________
Additional comments ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Mail to Connie Sutara, 110 Orchard Drive, Sarver, PA 16055
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