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Please wait until all files are uploaded before sending.","name":"uploadFiles","qid":"20","subLabel":"Limit 10MB","text":"Upload File(s)","type":"control_fileupload"},null,null,null,{"name":"doubleclickTo","qid":"24","text":"The consultants to the NSNA Board of Directors are:\nCheryl Taylor, PhD, RN, FAAN 聽Appointed by the National League for Nursing\nRosemary Mortimer, MSN, RN聽聽Appointed by the American Nurses Association\n","type":"control_text"},null,{"name":"submit","qid":"26","text":"Submit","type":"control_button"},null,null,{"name":"clickTo","qid":"29","text":"\n \nContact the NSNA Board of Directors, Nominating and Elections Committee, or ANA\u002FNLN Consultant","type":"control_text"}]);}, 20); </script> </head> <body> <form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://nsna.jotform.com/submit/31984835277872" method="post" enctype="multipart/form-data" name="form_31984835277872" id="31984835277872" accept-charset="utf-8" autocomplete="on"><input type="hidden" name="formID" value="31984835277872" /><input type="hidden" id="JWTContainer" value="" /><input type="hidden" id="cardinalOrderNumber" value="" /><input type="hidden" id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1732712770690" /><input type="hidden" id="submitSource" name="submitSource" value="unknown" /><input type="hidden" id="buildDate" name="buildDate" value="1732712770690" /><input type="hidden" name="eventObserver" value="1" /> <div role="main" class="form-all"> <ul class="form-section page-section" role="presentation"> <li class="form-line" data-type="control_text" id="id_29"> <div id="cid_29" class="form-input-wide"> <div id="text_29" class="form-html" data-component="text" tabindex="-1"> <h1 style="text-align: center;"><span style="font-size: 18pt;"><strong><img src="https://www.jotform.com/uploads/nsnainc/form_files/NSNAlogo-notagline.48.png" /></strong></span></h1> <h1 style="text-align: center;">聽</h1> <h1 style="text-align: center;"><span style="font-size: 18pt;"><strong>Contact the NSNA Board of Directors, Nominating and Elections Committee, or ANA/NLN Consultant</strong></span></h1> </div> </div> </li> <li class="form-line jf-required" data-type="control_fullname" id="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="first_3" aria-hidden="false"> Name<span class="form-required">*</span> </label> <div id="cid_3" class="form-input-wide jf-required"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_3" name="q3_name[first]" class="form-textbox validate[required]" data-defaultvalue="" autoComplete="section-input_3 given-name" size="10" data-component="first" aria-labelledby="label_3 sublabel_3_first" required="" value="" /><label class="form-sub-label" for="first_3" id="sublabel_3_first" style="min-height:13px">First 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myname@example.com" data-component="email" aria-labelledby="label_4" required="" value="" /><br /><label class="form-sub-label" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap" for="input_4_confirm">Confirmation Email</label><input type="email" id="input_4_confirm" name="q4_email4" class="form-textbox validate[required, Email, Email_Confirm]" data-defaultvalue="" autoComplete="nope" style="margin-top:8px" size="30" placeholder="Confirm Email" data-component="emailConfirmation" aria-labelledby="" value="" /></div> </div> </li> <li class="form-line" data-type="control_phone" id="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5_area" aria-hidden="false"> Phone (optional) </label> <div id="cid_5" class="form-input-wide"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode"><input type="tel" id="input_5_area" name="q5_phoneoptional[area]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_5 tel-area-code" data-component="areaCode" aria-labelledby="label_5 sublabel_5_area" value="" /><span class="phone-separate" aria-hidden="true">聽-</span><label class="form-sub-label" for="input_5_area" id="sublabel_5_area" style="min-height:13px">Area Code</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone"><input type="tel" id="input_5_phone" name="q5_phoneoptional[phone]" class="form-textbox" data-defaultvalue="" autoComplete="section-input_5 tel-local" data-component="phone" aria-labelledby="label_5 sublabel_5_phone" value="" /><label class="form-sub-label" for="input_5_phone" id="sublabel_5_phone" style="min-height:13px">Phone Number</label></span></div> </div> </li> <li class="form-line jf-required" data-type="control_radio" id="id_8"><label class="form-label form-label-top form-label-auto" id="label_8" aria-hidden="false"> I would like to contact:<span class="form-required">*</span> </label> <div id="cid_8" class="form-input-wide jf-required"> <div class="form-single-column" role="group" aria-labelledby="label_8" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_8" type="radio" class="form-radio validate[required]" id="input_8_0" name="q8_iWould" required="" value="Board of Directors Member" /><label id="label_input_8_0" for="input_8_0">Board of Directors Member</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_8" type="radio" class="form-radio validate[required]" id="input_8_1" name="q8_iWould" required="" value="Nominating and Elections Committee (NEC) Member" /><label id="label_input_8_1" for="input_8_1">Nominating and Elections Committee (NEC) Member</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_8" type="radio" class="form-radio validate[required]" id="input_8_2" name="q8_iWould" required="" value="ANA or NLN Consultant to the Board" /><label id="label_input_8_2" for="input_8_2">ANA or NLN Consultant to the Board</label></span></div> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6" aria-hidden="false"> Board Member </label> <div id="cid_6" class="form-input-wide"> <span class="form-sub-label-container" style="vertical-align:top"><select class="form-dropdown" id="input_6" name="q6_boardMember" style="width:300px" data-component="dropdown" aria-label="Board Member"> <option value="">Please Select</option> <option value="President">President</option> <option value="Vice-President">Vice-President</option> <option value="Secretary/Treasurer">Secretary/Treasurer</option> <option value="Imprint聽Editor">Imprint聽Editor</option> <option value="BTN庐 Director">BTN庐 Director</option> <option value="Director North">Director North</option> <option value="Director South">Director South</option> <option value="Director East">Director East</option> <option value="Director West">Director West</option> <option value="Ex-Officio, COSP Chair">Ex-Officio, COSP Chair</option> </select><label class="form-sub-label" for="input_6" id="sublabel_input_6" style="min-height:13px">Select Board member you want to contact.</label></span> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_17"><label class="form-label form-label-top form-label-auto" id="label_17" for="input_17" aria-hidden="false"> NEC Representative </label> <div id="cid_17" class="form-input-wide"> <select class="form-dropdown" id="input_17" name="q17_necRepresentative17" style="width:150px" data-component="dropdown" aria-label="NEC Representative"> <option value="">Please Select</option> <option value="NEC Chairperson - Western Election Area">NEC Chairperson - Western Election Area</option> <option value="NEC South - Southern Election Area">NEC South - Southern Election Area</option> <option value="NEC North - Northern Election Area">NEC North - Northern Election Area</option> <option value="NEC East - Eastern Election Area">NEC East - Eastern Election Area</option> </select> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_text" id="id_24"> <div id="cid_24" class="form-input-wide"> <div id="text_24" class="form-html" data-component="text" tabindex="-1"> <p><span style="font-size:12pt;"><strong>The consultants to the NSNA Board of Directors are:</strong></span></p> <ul> <li><span style="font-size:10pt;">Cheryl Taylor, PhD, RN, FAAN 聽Appointed by the National League for Nursing</span></li> <li><span style="font-size:10pt;">Rosemary Mortimer, MSN, RN聽聽Appointed by the American Nurses Association</span></li> </ul> </div> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_radio" id="id_15"><label class="form-label form-label-top" id="label_15" aria-hidden="false"> Choose Consultant: </label> <div id="cid_15" class="form-input-wide"> <div class="form-single-column" role="group" aria-labelledby="label_15" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_15" type="radio" class="form-radio" id="input_15_0" name="q15_chooseConsultant" value="Dr. Cheryl Taylor" /><label id="label_input_15_0" for="input_15_0">Dr. Cheryl Taylor</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_15" type="radio" class="form-radio" id="input_15_1" name="q15_chooseConsultant" value="Rosemary Mortimer" /><label id="label_input_15_1" for="input_15_1">Rosemary Mortimer</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_15" type="radio" class="form-radio" id="input_15_2" name="q15_chooseConsultant" value="Both Dr. Cheryl Taylor and Rosemary Mortimer" /><label id="label_input_15_2" for="input_15_2">Both Dr. Cheryl Taylor and Rosemary Mortimer</label></span></div> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_radio" id="id_19"><label class="form-label form-label-top form-label-auto" id="label_19" aria-hidden="false"> Are you attaching a file? </label> <div id="cid_19" class="form-input-wide"> <div class="form-single-column" role="group" aria-labelledby="label_19" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_19" type="radio" class="form-radio" id="input_19_0" name="q19_areYou" value="Yes" /><label id="label_input_19_0" for="input_19_0">Yes</label></span><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_19" type="radio" class="form-radio" id="input_19_1" name="q19_areYou" value="No" /><label id="label_input_19_1" for="input_19_1">No</label></span></div> </div> </li> <li class="form-line form-field-hidden" style="display:none;" data-type="control_fileupload" id="id_20"><label class="form-label form-label-top form-label-auto" id="label_20" for="input_20" aria-hidden="false"> Upload File(s) </label> <div id="cid_20" class="form-input-wide"> <div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top"> <div class="qq-uploader-buttonText-value">Upload a File</div><input type="file" id="input_20" name="q20_uploadFiles[]" multiple="" class="form-upload-multiple" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif, ppt, pptx, psd, msg, pub, log" data-file-maxsize="10240" 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