Application-Award

New Mexico Emergency Nurses Association

NM ENA Award Nomination Form – 2011

Nominee Name
Home Address Including city, state, zip
Nominee Phone Number
Nominee email address
ENA Membership Number
Current New Mexico License (yes or no, do not list license number)
Nomination category
Activities in support of nomination	(Attachment)
2 letters of support	(Attachment)
Your Signature

 

Send completed nominations to:

            Kathy Bell

            NM ENA Awards Committee

            14 Holiday Loop

            Tijeras, NM 87059

OR

            bellka55@yahoo.com

            H # 505-286-3866

 

Deadline for receipt of nomination is September 10, 2011

All nominations will be acknowledged via mail or e mail

Awards to be presented on Emergency Nurses Day