Life Membership Nomination Form

Nominee Details

Nominee Name(Required)

Nomination Details

Provide a detailed description of the nominee’s contributions to the College. Please include details of the duration of College membership and participation in and contribution to College activities, events, committees, or boards.
Provide a detailed description of the nominee’s contributions to critical care nursing. Begin by indicating the main area(s) of contribution (Research, Education, Leadership or Patient Care/Clinical Practice), and then provide evidence of the nominee’s notable contribution(s).
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    Upload any relevant documentation related to the nominees contributions to the ACCCN and critical care nursing.

    Nominator Details

    Nominator Name(Required)
    Declaration(Required)