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 Friday, October 24, 2014
 
 
 

ONLINE CHAPTER FORMATION APPLICATION


In addition to the form below, the following items must also be submitted to the SVN:

  • Application Fee ($60.00 - payable to SVN)
    Mail to: Society for Vascular Nursing
    Attn: Chapter Services Specialist
    100 Cummings Center, Suite 124A
    Beverly, MA  01915
  • Chapter Member Biography Forms - submit one for each member of your new chapter
Name of New Chapter:
(Chapter name must include SVN in title. Geographical location is recommended to be used.)
Contact Person (include credentials/title):
Preferred Mailing Address (Line 1):
Preferred Mailing Address (Line 2):
City:
State:
(leave blank if outside US)
Country:
Zip Code:
Phone (daytime):
Phone (evening):
Fax:
Email Address:
Chapter Address (Line 1):
Chapter Address (Line 2):
City:
State:
(leave blank if outside US)
Country:
Zip Code:
Will chapter be affiliated with an institution?
If "Yes", give name and type of institution:
Number of Chapter Members:

Names of Chapter Members (separate with commas):
Note: you must fill out a Chapter Member Biography Form for each member you list here


Chapter Charter/By-laws:
(Instructions for Pasting Text: On a Windows computer (1) highlight the text in your text editor, such as Microsoft Word (2) while still hovering over the highlighted text, right click and choose "Copy" from the menu (3) right click in the box below and choose "Paste" from the menu.)

1-2 page summary of the Chapter's vision including the following topics: Overall mission of chapter, short and long term goals, proof of financial independence, leadership roster and upcoming activity plans for the next year.

What is 7+1?
(This is to ensure the form is being submitted by a person, not an automated spamming script.)