Nomination Form

First name*

Last name*

Email*

Address*

Phone*

Position(s) of Interest *

Which of the open board positions or committees are you interested in?

Registration (Select All that Apply)*

Licensed Practical Nurse

Registered Psychiatric Nurse

Registered Nurse

Nurse Practitioner

Retired

Student

Do you work in the Yukon?*

Yes

No

Do you live in the Yukon? *

Yes

No

Expression of Interest*

Provide a short expression of interest on the role you are applying to.

Resume *

Have you familiarize yourself with our bylaws? Specifically bylaws 23, 24, 25. If so please check this box.

Signature*

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Yukon Nurses Alliance

info@yukonnursesalliance.com

867 - 689 - 4160

Yukon, Canada

Connect with Us

Email*

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We acknowledge that we meet and gather on the traditional territories of the Kwanlin Dün First Nation and the Ta'an Kwäch'än council. We recognize that nurses of the Yukon work, live and play on the traditional territories of all Yukon First Nations.

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