Chapter Membership Survey

Which chapter do you belong to? *

Alabama

Arizona

Arkansas

California: Los Angeles

California: Orange County

California: Sacramento

California: San Diego

California: San Francisco Bay Area

California: San Joaquin

Colorado: Rocky Mountain

Connecticut

eChapter

Florida

Florida: Gulf Coast

Georgia

Hawaii

Illinois: Chicago

Indiana

Iowa

Kentucky

Maryland: Chesapeake

Massachusetts

Michigan

Minnesota

Missouri: Greater Kansas City

Missouri: St. Louis

NE: Midwest Chapter

New Jersey

New York Greater

New York Long Island

New York Upstate

New York Western

North Carolina

North Carolina Charlotte

Ohio

Oklahoma

Oregon

Pennsylvania Delaware Valley

Pennsylvania Three Rivers

South Carolina

Tennessee: Blues City

Tennessee: Music City

Texas: Austin

Texas: Greater

Texas: Houston

Texas: South Alamo

Texas: Southwest

Utah

Virginia

Virginia: Hampton Roads

Washington DC

Washington State

Wisconsin

First Name

Last Name

Email Address

What is your age range? *

How many years have you been part of this chapter? *

What is your highest education level? *

What type of certification do you hold? *

Please rank the way you would like to be informed about chapter events with 1 being the most preferred and 4 being your least preferred:

	Email
	Facebook
	LinkedIn
	Instragram
	Newsletter

How often should we be corresponding to you? *

How many in person or virtual CE events should the chapter hold? *

Monthly

Bi-monthly

Quarterly

What type of topic would you like presented at a CE event? *

Would you attend a social event (either in person or virtually) that does not offer CE? *

If our chapter is able to host a virtual conference and provide CE, how much are you willing to spend for registration? *

How can the chapter better serve you? What additional resources should the chapter provide? *

Are you involved and/or leaders in other professional nursing organizations? If so, which ones?

If you would like to volunteer as a leader on the board, please include your email address so we can contact you directly: