THE VILLAGES NURSES CLUB
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The Villages Nurses Club


THE VILLAGES NURSES CLUB
MEMBERSHIP FORM    

We would like to showcase our own talent and recognize our own expertise within The Villages Nurses Club.  Please share with us what has made your nursing journey memorable and please let us know of other skills/interest you have that could be shared.


Please Print 


Name: _________________________  Date:______________


Credentials/Degrees: (check one) 


ARNP____RN___LPN___ AS degree___ BA___BSN__MSN_____


PhD Nursing___ Attorney___ Military Rank__________


Address:  _________________________________________



City, Zip__________________________________________ 



Village__________________ Full time  _____ Seasonal  ____



Phone Number:                                   Cell:________________


e-mail address:__________________________________

1) Would you be interested in serving as a committee Chairperson or a member of a Club Committee?  Y      N   

  
Committees are: Membership; Nominating; Program; Refreshment; Sunshine; 50/50, Christmas Party, May Celebration


2) Area of specialty?  Do you or did you leave a foot print in nursing?  Did you author a text; a Professor; serve in the military or other world organizations; are you an attorney? 




3) Are you willing to give a short talk (to the club) about your accomplishments?



If you have questions or comments please, contact:

           President: Madge Koscelnik



www.TheVillagesNursesClub.com 

If you need more room please, write on back.. Thanks for your input.


Created by Lyn McElwee