Individual Member
Organization Member

Your First Name:

Your Last Name:

Your Organization:

Your E-Mail Address:


If applying as an organization member:
Type of Organization:
Nursing Professional
Trade Association
Hospital
Home Care
Educational Institution
Educator Association
State Agency
Media
Long-term Care
Assisted Living
Hospice
Other, please specify:

    

Name and Position/Title of Person who will represent your organization:

First Name:

Last Name:

Title:

Employer:

How long in this position?

How long with this employer?

Contact Address:

City:

State:

Zip:

Phone:

Fax:

E-mail:


I would like to be a member of the following ICNR committee(s):

Recruitment
Retention
Legislation
Funding
Communications

I would like to be a member of the following ICNR task force(s):

Education Articulation
Educational Programs

Membership Dues:

$50 Individual Member
$275 Organization Member

When the ICNR e-newsletter is available, would you like to be included on the mailing list?
Yes
No

If yes, please indicate which e-mail address we should use to send the e-newsletter to you:
Home
Work
Both

Are you interested in being included in the ICNR Speakers' Bureau? The Speakers' Bureau section on this Web site will list the names and e-mail addresses of ICNR members who are available to talk about nurses and nursing careers at grade, elementary and high schools, summer camps, as well as community events, career/job fairs and churches.
Yes
No

Our plan is to first identify members throughout the state who want to be ambassadors for nursing and the ICNR. Then, we will drive traffic to the Speakers' Bureau section by sending letters to guidance counselors and school principals/superintendents to let them know there are ICNR members available to speak at their school. Eventually, we will network with churches throughout the state and career fair vendors.

If yes, please list the towns or geographical areas in Illinois in which you would be willing to speak:


Are you interested in hosting a Web chat session, in which you would talk about your area of practice, for children/young adults, parents and/or those considering a career in nursing? If yes, please indicate your area of practice and/or topics of expertise below. Also, please indicate which month you would like to host the nursing career chat session. Beginning January 2003, we plan to assign 1-2 ICNR members each month to act as the chat "host." We will advertise our chat sessions in community papers, the local media and schools.
Yes, I am interested in hosting a Web chat session

Area of Practice/Topics of Expertise


Month would like to host Web chat session

No, I am not interested in hosting a Web chat session

Are you interested in being interviewed by the media in your community?
Yes
No

Initially, members of the Board will serve as media spokespersons. Eventually, we would like to list, by region, ICNR members who can be contacted by local media for interviews. Talking points will be provided to all ICNR spokespersons (at some point in the future we can schedule mini media training as well). Our plan is to send letters to various reporters (print, radio, TV/cable) and TV and radio producers to inform them of the ICNR spokesperson in their community. The spokespersons will also soon be listed in the Newsroom section of this site.

Please mail your dues check, made payable to the Illinois Coalition for Nursing Resources/IHA, to:

Illinois Coalition for Nursing Resources
c/o the Krier company
3N437 Norris Avenue
West Chicago, Illinois  60185

Thank you!