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:_______________________



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; or you an attorney? 



3)  Do you have a musical talent? Sing or play an instrument?




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



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If you have questions or comments please, contact:
President: Marilyn Lanzone
Vice President: Madge Koscelnik
www.TheVillagesNursesClub.com 


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


Created by Lyn McElwee