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Nursing Education

Appointed Positions Interest Form
Deadline: October 31, 2011

* Required

*First Name:**
*Last Name:**
*Credentials:**
NLN Membership No.:
*Email Address:**
*Preferred Address:**	Business Home
*Address 1:**
Address 2:
*City:**
*State:**
*Zip:**
*Preferred Phone:**	Business Home
*Phone Number:**

I am interested in the following appointed position(s):*
Certification Test Development Committee*
Education Summit Program Planning Work Group

*Applicants must hold the CNE credential

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