National Nurses United

Registered Nurse December 2006

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Election 1/9/07 1:05 PM Page 19 d Biographical Sketch MEMBERSHIP INFORMATION I have been a member of the California Nurses Association/National Nurses Organizing Committee since _____(year). I am willing to accept the responsibilities of this position. Date: ______________________________________Signature: ________________________________________________________________________ MEMBER'S STATEMENT OF INTEREST (CNA/NNOC Officer or Board of Directors only) Please write a brief statement (50 words maximum), indicating how your involvement would help increase the power of registered nurses and the California Nurses Association/National Nurses Organizing Committee to advocate for RNs, patients, and a just healthcare system. (Statements will be truncated after 50 words.) _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ Signature _________________________________________________________Name ______________________________________________________ ——————————————————————————————————————————————————————————————————————————— FOR OFFICE USE ONLY: Member ID #: ___________________________________________________Status: ______________________________________________________ Date: _______________________________________________________Checked by: ______________________________________________________ DECEMBER 2006 W W W. C A L N U R S E S . O R G REGISTERED NURSE 19

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