ASPMN® Recommendation for Nomination
for Board of Directors/Nominating Committee

Submitted form will automatically be sent to:
ASPMN Executive Office
673 Potomac Station Drive, #801
Leesburg, VA 20176
(571) 831-8181


Step 1: Please read the position descriptions and qualifications from the Nominations Committee.

Step 2: Please enter the following information, then click the "Confirm" button at the bottom of this page:

Nomination for:
  First Middle Last Credentials/Degrees
  Street City State Zip Code
E-Mail: Telephone: ()-  


ASPMN® Participation: (List present to past)

Member since:

For the following text fields, we suggest that you type your answers in a word processor and then paste your entries in the fields below. Please limit your entry in this and all subsequent text boxes to a maximum of 750 characters each.

Board positions held and year(s) served. :

Committee(s), position(s) and year(s) served:

Chapters(s), position(s) and year(s) served:

Professional Experience:(List present to past) Job Title, Institution, City/State, and date(s) of employment:

Experience in field as RN/APN in Pain Management Nursing: years

Education: (List present to past) Degree(s) earned and date(s):

Certifications: (List dates):

Personal Statement: (200 word limit; What qualifies you to seek this position? Candidates: Please direct this statement to the Nominations Committee at this time, not the ASPMN® Membership.)

Consent: I verify (or have verified with the proper party) willingness to serve on the ASPMN® Board of Directors or Nominating committee.

Signed: Date:
Email address:
No robot question:

Receipt of this Recommendation Form will be acknowledged via e-mail within two (2) business days of receipt in the Executive Office. If an acknowledgement is not received within this time frame, please contact the Executive Office at (571) 831-8181.

Please note that a recommendation/nomination does not guarantee that the person's name will appear on the slate.  Self nominations are permitted.






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