PAPAN - Form
                Honorary Membership Nominations Form - Step Two
Pennsylvania Association of PeriAnesthesia Nurses

                                               

                Honorary Membership Nomination Form

Step Two: To be completed by the nurse being 
               nominated.     

Name (including middle): _______________________

Home address: ________________________________
                      
City, State & Zip: ______________________________

Please attach current resume of curriculum vitae.



I agree to be considered for Honorary Membership
as stated in the bylaws of the Pennsylvania Association
of PeriAnesthesia Nurses (PAPAN).  I agree to
participate in the award ceremony if chosen.

Signature: _____________________________________

Date: _________________________________________


Complete and mail to Membership Chairperson   
F. Blatchley
215 Front Street, Box 101
New Berlin, PA 17855

Info@papanonline.org
  
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