ANA-NY Committee Interest Form
Submissions must be received by Friday, July 10, 2026
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select Committee of Interest
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Please Select
Audit
Bylaws
Finance
Legislation
Awards
Nursing Education
Why are you interested in this committee?
*
Please provide relevant experience, if any
What is your practice area?
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Submit
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