Colorado Emergency Nurses Association 2012 Delegate Point Sheet

The completed Point Sheet and required supporting documents must be received by Sharon Sperry, Delegate Chair, by the start of the June 28th, 2012 meeting in Breckenridge. Delegates will be notified by June 30th. At the conclusion of the General Assembly, Delegates will receive $1000 (taxable income). Please email this form to sperryena@live.com

Activity
2012 Board of Directors President President Elect Secretary Treasurer Immediate Past President 2012 Meeting Attendance2012 Meeting Attendance Jan 5, Memorial Hospital North April 10, Memorial Hospital North June 28 Breckenridge, CO

Point Value
20 20 20 20 20

Sub-Total

10 points per meeting

Certifications- MUST include copy of current card CEN CPEN ENPC- Provider ENPC- Instructor, Course Director and/or State Faculty TNCC- Provider TNCC- Instructor, Course Director and/or State Faculty CATN- Instructor and/or Course Director Other- please provide documentation Committee Activity Volunteer at the ENA its a small world. Colorado State Conference Local ENA Committee Chair points awarded if active in committee First Quarter Report submitted as requested Second Quarter Report submitted as requested Local ENA Committee Member (ED Liaison) Attendance at Committee Meeting or Conference Call National Committee member-include summary of activity Please provide documentation of other activities you would like the Board to consider. Examples: Injury Prevention Activities or related courses Publications (JEN, other Professional Journals)

10 10 5 10 each 5 10 each 10 each Board decision 10 10 5 5 10 2 each Board decision

Board decision

TOTAL POINTS
Complete ALL questions below: Have you ever served as an ENA delegate in the past? ____________ All delegates will be asked to purchase a Colorado ENA shirt. Shirt Size? XS S M L XL Name______________________________ Best contact number and/or email___________________________________________ I hereby acknowledge that I have read and understand the requirements and responsibilities required of a delegate I hereby acknowledge that I am NOT receiving reimbursement to attend the National ENA General Assembly from another source. Being a delegate is a privilege and a representative of both members and non-members of Colorado ENA. To ensure the best representation for Emergency Nurses in Colorado all delegates will be assigned a (or a delegate may request upcoming) subject matter or upcoming resolutions or bylaw amendments. This assignment will result in the delegate becoming the state expert/representative at the national assembly and the Colorado meeting prior to the national assembly.

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