Inside this section

2010 HOD Alternate Delegate Form

Please complete an Alternate Delegate Form if you wish to be considered as a delegate to MNA's House of Delegates meeting during the Convention, to be held October 17 - 19 in Duluth.

Option 1. Use the interactive form below

Option 2. Use the PDF form, complete (you can enter your information electronically), copy and mail/fax to Minnesota Nurses Association, attn: Kelli Eisenschenk 345 Randolph Avenue Ste. 200, St. Paul, MN 55102

MNA members in good standing who did not appear on the ballot may submit an Alternate Delegate form between MNA elections to become alternates to the annual meeting of the MNA House of Delegates. Alternates to the annual meeting of the MNA House of Delegates shall be eligible to fill vacant delegate slots in accordance with MNA policy and procedures.

Any member in good standing may obtain the Alternate Delegate form from the MNA office. The Alternate Delegate form will also be printed at least annually in the official publication of MNA, the MINNESOTA NURSING ACCENT, and on the MNA web site.

Submitted by: MNA Board of Directors September 9, 2004

Adopted by: MNA House of Delegates October 20, 2004

Name: *

Member Number: *

Your membership number is located at the lower-left of your membership card.

Email: *

Date: *

I wish to be listed as an alternate delegate to the 2010 MNA House of Delegates.

I understand the 2010 House of Delegates will be held October 17-19 during MNA’s Annual Convention at the DECC in Duluth, Minnesota, and if I am moved up to delegate status, I understand that I must attend the entire House of Delegates.

Understand and Agree to the Above Terms?: *

Yes