MASPAN
Willingness to Serve Form


Name:             __________________________________________________________________

Address:         __________________________________________________________________

City/State/Zip: _________________________________________________________________

Telephone:     ____________________________           Email: ______________________________

ASPAN Member #:  ____________________________________________________________


I am interested in learning more about:
(Please circle one)

Membership Committee        Education/Conference Planning        Strategic Planning

Fundraising Committee         Publication Committee                       Government Affairs Committee


I am interested in serving on the following committee:
(Please circle one)

Membership                                Education                                Fundraising                

Government Affairs                    Strategic Planning                    Publication


Please send to:           Ellen Sullivan, BSN, RN, CPAN
            MASPAN Membership Chairperson
            137 Tiffany Rd.
            Norwell, MA 02061
            esullivanrn@maspan.org
             W: 617-732-7305