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.

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