2009 Delegate Form for the 56th AORN Congress Chicago, IL
Deadline for Submission is February 13, 2009*
I am willing to serve Mass Chapter 1 as a Delegate or Alternate Delegate at the 2009 Congress.
My AORN Membership expires on: (required)
Is this your first Congress? Yes No
City, State, Zip:
Home phone: Work phone:
Employer/Manager’s mailing address:
The following is the point system for Chapter Delegates/Alternate Delegates.
ACTIVITY ADDITIONAL INFO POINTS POINTS
Office of Chapter List: 5
Chair Committee/Task Force List: 4 each
Member Committee/Task Force List: 2 each
Immediate Past President 2
Monthly AORN Meetings Check all that apply: May 08 1 each
Attended Nov 08 Jan 09 Feb 09
Workshop Attendance Check all that apply: Spring08 2 Each
Recruited New Member(s) Name(s): 1 each
Presenting Program/Speaker at List: 4 each
AORN Chapter or National
National Committee and/or List: 2 each
Writing for Newsletter/ Submit Copy if possible 2 each
Monitor/Teller/Congress 2 each
TOTAL POINTS EARNED YOU MUST SUBMIT THE POINTS
TO BE CONSIDERED!
POINTS ARE ACCUMULATED IN THE CALENDAR YEAR BEFORE CONGRESS. POINTS ARE
SUBJECT TO VERIFICATION BY THE CONGRESS COMMITTEE.
Please return completed form in person, postal mail or email to:
51 Presentation Rd #2
Brighton, Ma 02135