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Position 1:
--Select-- Administrator/Director
Cert Registered Nurse Anesthetist
Certified Nurse Midwife
Clinical Nurse Specialist
Educator - Service
Educator _ Academic
Informatics Specialist
Nurse Attorney
Nurse Practitioner
Researcher
Staff Nurse
Supervisor/Manager
Position 2:
--Select-- Administrator/Director
Cert Registered Nurse Anesthetist
Certified Nurse Midwife
Clinical Nurse Specialist
Educator - Service
Educator _ Academic
Informatics Specialist
Nurse Attorney
Nurse Practitioner
Researcher
Staff Nurse
Supervisor/Manager
Employment Status:
--Select-- Full-time in Nursing
Full-time not Nursing
Part-time in Nursing
Part-time not Nursing
Retired
Self-Employed
Student (at least 50%)
Unemployed
Birthday:
(mm/dd/yyyy)
Graduation Date:
(mm/dd/yyyy)
License #:
License State:
Gender:
--Select-- Female
Male
Highest Level of Education:
--Select-- Diploma
ADN
BSN
Bacc./Other
MSN
Master/Other
Doc/Nursing
Doc/Other
J.D.
Salary:
--Select-- Less than $12,000
$12,000 - $24,999
$25,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
$80,000 - $99,999
$100,000 +
Councils/Advisory Groups:
Gerontological Nursing
Simulation
Nurse Practitioners
Nursing Informatics
Psychiatric MH Nurse
APRN
Left Click to select one item, hold CTRL + Click to select more than one or to de-select an item.
Race:
--Select-- Caucasian
African American
Hispanic
American Indian
Asian/Pl
Other
Other:
Political Party:
--Select-- Democrat
Republican
Independent
Not Registered
Please enter your Voting District Numbers in the fields below:
US House:
NC House:
NC Senate:
* Select County preferred for regional membership:
--Select-- ALAMANCE - District 08
ALEXANDER - North West Region
ALLEGHANY - North West Region
ANSON - District 05
ASHE - North West Region
AVERY - North West Region
BEAUFORT - Northeast Region
BERTIE - Northeast Region
BLADEN - District 15
BRUNSWICK - District 22
BUNCOMBE - Mountain Region
BURKE - North West Region
CABARRUS - District 05
CALDWELL - North West Region
CAMDEN - Northeast Region
CARTERET - District 21
CASWELL - District 08
CATAWBA - North West Region
CHATHAM - Triangle Region
CHEROKEE - Mountain Region
CHOWAN - Northeast Region
CLAY - Mountain Region
CLEVELAND - District 29
COLUMBUS - District 16
CRAVEN - District 21
CUMBERLAND - District 14
CURRITUCK - Northeast Region
DARE - Northeast Region
DAVIDSON - District 09
DAVIE - District 03
DUPLIN - District 21
DURHAM - Triangle Region
EDGECOMB - Northeast Region
FORSYTH - District 03
FRANKLIN - Triangle Region
GASTON - District 29
GATES - Northeast Region
GRAHAM - Mountain Region
GRANVILLE - Triangle Region
GREENE - Northeast Region
GUILFORD - District 08
GUILFORD/High Point Area - Dist. 09
HALIFAX - District 17
HARNETT - District 14
HAYWOOD - Mountain Region
HENDERSON - Mountain Region
HERTFORD - District 17
HOKE - District 15
HYDE - Northeast Region
IREDELL - North West Region
JACKSON - Mountain Region
JOHNSTON - Triangle Region
JONES - District 21
LEE - Triangle Region
LENOIR - District 21
LINCOLN - District 29
MACON - Mountain Region
MADISON - Mountain Region
MARTIN - Northeast Region
MCDOWELL - Mountain Region
MECKLENBURG - District 05
MITCHELL - Mountain Region
MONTGOMERY - District 09
MOORE
MOORE-Northern - Triangle Region
MOORE-Southern - District 15
NASH - Northeast Region
NEW HANOVER - District 22
NORTHHAMPTON - District 17
ONSLOW - District 21
ORANGE - Triangle Region
OUT-OF-STATE
PAMLICO - District 21
PASQUOTANK - Northeast Region
PENDER - District 22
PERQUIMANNS - Northeast Region
PERSON - Triangle Region
PITT - Northeast Region
POLK - Mountain Region
RANDOLPH - District 09
RICHMOND - District 15
ROBESON - District 15
ROCKINGHAM - District 08
ROWAN - District 05
RUTHERFORD - District 29
SAMPSON - District 14
SCOTLAND - District 15
STANLY - District 05
STOKES - District 03
SURRY - District 03
SWAIN - Mountain Region
TRANSYLVANIA - Mountain Region
TYRRELL - Northeast Region
UNION - District 05
VANCE - Triangle Region
WAKE - Triangle Region
WARREN - District 17
WASHINGTON - Northeast Region
WATAUGA - North West Region
WAYNE - Northeast Region
WILKES - North West Region
WILSON - Northeast Region
YADKIN - District 03
YANCEY - Mountain Region
* Select the District or Region to which your County belongs:
===District/Region===
District 03
District 05
District 07
District 08
District 09
District 14
District 15
District 16
District 17
District 21
District 22
District 29
Mountain Region
North West Region
Northeast Region
Triangle Region