POLICY AND PROCEDURE
MANUAL
ASSOCIATION
OF
PERIANESTHESIA
NURSES
Revised: 9/03. 4/09,
1/10, 7/11
SECTION TITLE PAGE
01 Job Descriptions
01-100
President 3
01-101
President-Elect 5
01-102
Immediate Past President 6
01-103
Secretary 7
01-104
Treasurer 8
01-105
Membership Chair 9
01-106
Legislative Chair 10
01-107 Historian 11
01-108 Newsletter Editor 12
01-109 Website Editor
01-110 Committee Chairperson 13
02 Committees
02-100 Seminar Committee 14
02-101 Bylaws, Policy & Procedures Committee 15
03 Financial
03-100 Travel Expenses 16
03-101 Special Seminar Reimbursement 17
03-102 GAPAN Dues and District Reimbursement 18
04 District
Responsibilities
04-100 District Responsibilities 19
05-100 GAPAN/GSA Annual PeriAnesthesia Nurse
Scholarship 20
05-101 GAPAN Recruiter of the Year 21
06-100 Consent to Print 22
Job Description
Job Title:
President Policy
# 01-100
Reports to: Board
of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The President is the principal officer of the Georgia
Association of PeriAnesthesia Nurses (GAPAN) and in collaboration with the
Board of Directors administers the affairs of the Association according to its
Bylaws and Policies & Procedures.
Job Duties and Responsibilities:
1.
Responsible to the Board Of
Directors and has approval of the Board for activities of the Association.
2.
Preside over Board of
Directors meetings, annual meeting and special meetings.
3.
Represent the Association at
meetings of other organizations or designate an alternate to serve in the
President's place.
4.
Serve as member ex‑officio
of all committees.
5.
Direct the preparation of
all official correspondence of the Association.
6.
Serve as the designated liaison
between GAPAN and GSA.
7.
Request, in writing, a donation from
the GSA for the PeriAnesthesia Nurse of the Year Award.
8.
Prepare an agenda for all
meetings of the Association and the BOD and forward to the State Secretary
prior to the scheduled BOD Meeting. The agenda should be prepared at least 14 days prior the scheduled BOD
Meeting.
9.
Mentors the President-Elect
to assume the duties of the office.
10.
Shall state goals and
objectives at the first scheduled BOD meeting.
These goals and objectives will be evaluated at the last BOD meeting for
that term of office.
11. Prepare
message for publication in each addition of The Awakener/ Website.
12.
All financial transactions by
the treasury/ treasurer in excess of
fifty dollars must have written approval ( including electronic).
Electronic records must be maintained in the same fashion as traditional
business records by the treasurer.
13. Serve
as a liaison between ASPAN and GAPAN.
14. Represent GAPAN at ASPAN National
Conference:
A. Review nominees for officers and receive GAPAN
members’ choices for election from ASPAN.
B. Prepare and submit agenda item to be
presented at the ASPAN Representative Assembly.
C. Attend ASPAN Representative Assembly and vote
as directed by GAPAN Board of Directors.
D. Attend Council of Component Presidents
meeting.
E. May be asked to be a moderator of educational
sessions.
15. Updates Board of Directors of ASPAN
activities at board meetings or as needed.
16.
Act as a resource person for GAPAN members requesting information
regarding
ASPAN activities.
17. Promote
the professional image of GAPAN by appropriate dress and conduct at functions
when serving in an official capacity.
18. Serve
on committee or as chairperson of committees as requested by ASPAN President.
19. Assist
National Conference Chairperson and Conference Committee as needed when
conference is held in home state.
20. Prepare
an end of term summary for presentation to the membership at the annual state
meeting.
Job Description
Job Title:
President-Elect Policy
# 01-101
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09,
Primary Purpose of the Job:
The President-Elect witnesses the administration of the
affairs of the Georgia Association of PeriAnesthesia Nurses (GAPAN) in
preparation of his/her term of office as President, and by active aid to the
President, acquaints himself/herself with the duties and responsibilities of
the office of the President.
Job Duties and Responsibilities:
1.
Observe and assist the
President in preparation for the duties and responsibilities for that office.
2. Available
to represent the President and the Association at other professional meetings
as delegated by the President.
3.
Serve as a member, ex‑officio
on standing and special committees.
4.
Serve as Chairperson of the
Bylaws and Policy & Procedures Committee and submit Bylaws changes to
ASPAN.
5. Act
as Parliamentarian at the BOD meetings with strict adherence to Robert's Rules
of Order.
6.
Obtain gift for the outgoing
President, Program Chair(s) and plaques for new honorary members: all of which
are presented to the recipients at the Annual State Meeting. Each gift is not to exceed $50.00.
7. Represent GAPAN at ASPAN National
Conference:
A. Review nominees for officers and receive GAPAN
members’ choices for election from ASPAN.
B. Prepare and submit agenda item to be
presented at the ASPAN Representative Assembly.
C. Attend ASPAN Representative Assembly and vote
as directed by GAPAN Board of Directors.
D. Assure participation of GAPAN on Component
night during National Conference.
E. May be asked to be a moderator of educational
sessions.
8. Assist
National Conference Chairperson and Conference Committee as needed when
conference is held in home state or region.
9.
Promote the professional image of GAPAN by appropriate dress and conduct
at functions when serving in an official capacity.
Job Description
Job Title:
Immediate Past President Policy
# 01-102
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09
Primary Purpose of the Job:
The Immediate Past President shall make himself/herself
available for consultation to the President and shall assist other Georgia
Association of PeriAnesthesia Nurses (GAPAN) leaders and members as requested
by the President or the Board of Directors.
Job Duties and Responsibilities:
1.
Is available to President
for advice and counsel.
2.
Assume
duties as designated by President.
3.
Submit
Gold Leaf Award Application to ASPAN.
4.
Promote the professional image of GAPAN by appropriate dress and conduct
at functions when serving in an official capacity.
Job Description
Job Title:
Secretary Policy
# 01-103
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Secretary maintains all records of the Georgia
Association of PeriAnesthesia Nurses (GAPAN) except financial records.
Job Duties and Responsibilities:
1.
Record and maintain original
minutes of all meetings of the Association.
Submit the minutes of the previous meeting for approval at the next
meeting. All language used in correspondence should be concurrent with that
used by ASPAN.
2.
Send a copy of the minutes
to the President following the meeting for review prior to distribution. The
minutes for the previous meeting should be submitted to the president for
approval at a minimum of 21 days prior to he next scheduled BOD.
3.
Send minutes of previous
meeting (after Presidential approval), notification of next meeting, and agenda
to all BOD members at least 14 days prior
to the next meeting.
4.
Receive and maintain all committee reports.
5.
Compile and distribute a directory of Board Members at the beginning of
each new Board. Compile and distribute a
directory of district officers to the Executive Board.
6.
Provide ASPAN with a list of officers.
7.
Serve as the official correspondent of GAPAN.
8. Promote the professional image of GAPAN
by appropriate dress and conduct at
functions when serving in an
official capacity.
Job Description
Job Title:
Treasurer Policy
# 01-104
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Treasurer is accountable for all assets, accounts, and
securities of the Georgia Association of PeriAnesthesia Nurses (GAPAN) as
directed by the Board of Directors.
Job Duties and Responsibilities:
1.
Maintain all financial
accounts and records of the Association, including respective oversight of the seminar account.
2.
Obtain the President’s written approval for Association expenditures
(greater than 50 dollars) to include electronic communication and transfers.
All expenditures must be for the conduction of GAPAN business transactions .
3. Present financial report at each Board
meeting and provide copies for the Board members.
4.
Present financial report at the
5.
Obtain the services of a CPA
for annual audit/ financial review.
6.
Distribute the Tax ID Number
to all District Treasurers at the time of the district formation.
7.
Assist Officers, Board Members and Chairpersons with the proper
reimbursement
procedures.
8.
Responsible for disbursement of
district dues to district Presidents.
9.
Responsible for disbursement of
compensation to The Awakener/ Website authors.
10.
Maintain incorporated status with
the state of
11.
Promote the professional image of GAPAN by appropriate dress and conduct
at functions when serving in an official capacity.
12.
Maintain records of any inactive district treasury.
Job Description
Job Title:
Membership Chair Policy
# 01-105
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Membership Chair is responsible for recruiting members
and is the membership liaison for the Georgia Association of PeriAnesthesia
Nurses (GAPAN).
Job Duties and Responsibilities:
1.
Serves as the chair for the
Nomination Committee. The Chair is responsible for submitting a slate of
officers at least 14 days prior to the
2. Maintain current membership list and
distribute to the Board of Directors.
3. Function as the membership liaison with
ASPAN.
5. Provide
district membership information to the state Treasurer for disbursement of
GAPAN dues.
6. Submit a written report at each Board of
Directors meeting and a summary to the
President, prior to the
7. Obtain recruitment information from ASPAN
to determine GAPAN Recruiter of
the Year.
8.
Promote the professional image of GAPAN by appropriate dress and conduct
at functions when serving in an official capacity.
Job Description
Job Title:
Governmental/ Legislative Affairs (Chair)
Policy
# 01-106
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Governmental/ Legislative Affairs Chair monitors
national, state and local legislative and regulatory issues affecting nursing
and health care and is the Legislative liaison for the Georgia Association of
PeriAnesthesia Nurses (GAPAN).
Job Duties and Responsibilities:
1. Advise the membership on governmental/
legislative affairs at meetings and through The
Awakener/ Website.
2. Comply with the ASPAN policy #09-200
“Component Governmental Affairs
Representative”.
3.
Promote the professional image of GAPAN by appropriate dress and conduct
at functions when serving in an official capacity.
4.
Acts as the official governmental liason representative (internal and external)
of GAPAN with ASPAN and other organizations such as GNA,
ANA, and other professional healthacare associations.
5. Acts as the official chair of the
GAPAN Government Affairs Committee (
committee formed of active GAPAN
members in monitoring and lobbying
governmental affairs pertainging to nursing, heathcare legislation and legislation affecting
the practice of Perianesthesia Nursing.
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Historian is responsible for maintaining the history of
the Georgia Association of PeriAnesthesia Nurses.
Responsibilities:
1. Prepare and maintain a history of the
organization from the date of its founding.
2. Compile and maintain the history of the organization. This may
include electronic storage.
3. Make historical items available for review
at the Annual Meeting of members.
Effective Date: September,
2003, Revised April 09
Primary Purpose of the Job:
The Newsletter Editor is responsible for publishing and
distributing The Awakener
Responsibilities:
1. Publishes (hardcopy or electronically)
and distributes The Awakener three (3) times a year.
2. Obtains the Consent to Print form from
each author of an article.
3. Requests author compensation from the
Treasurer.
Effective Date: April
09
Primary Purpose of the Job:
The Website Editor is responsible for publishing and
maintaining copy for www.ga-pan.org.
Responsibilities:
1. Obtains Board and District officer
information and maintains current listings on website.
2. Updates district reports quarterly or as
needed
3. Maintains GAPAN calendar
4. Promotes educational offerings via
website
5. Maintains active promotion of
scholarship/awards opportunities via website.
6. Maintains professional content standards
for copy.
7. Provides ASPAN and Region 5 director with
updates.
8. Obtains the Consent To Publish form from
each author of an article, as applicable.
9. Requests author compensation from the
Treasurer, as applicable.
Job Description
Job Title:
Committee Chairperson Policy
# 01-110
Reports to: President
and Board of Directors
Effective Date: September,
2003, Revised April 09, Jan 10
Primary Purpose of the Job:
The Chairperson of each committee, or
work team, coordinates the work of that committee as directed by the Georgia
Association of PeriAnesthesia Nurses (GAPAN) President or Board of Directors.
Job Duties and Responsibilities:
1.
Meet with the immediate Past
Chairperson to receive information and material pertinent to continuing the
goals of the committee.
2.
Provide reports of committee
activity at each Board of Directors meeting.
3. Organizes and directs general activities
of committee members and reports activities
to President-elect at least quarterly
by report directly or electronically.
4. Serves as the Treasurer of the Committee,
handling all expenses of the
Committee. The chair should inform
and provide duplicate legible copies of any or all expenditures to the Treasurer quarterly.
5. Submits a written year end report to the
President and Board of Directors.
6. At the conclusion of term as Chairperson,
the chair will meet with the incoming Chairperson to
transfer pertinent committee
information and serve as a reference person for the next chair.
Effective Date: September,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to define the function of the Seminar Committee.
Responsibilities:
1. The Seminar Committee may consist of no
more than six members, including the chair(s).
2. Continuing education application is to be
completed per an ANCC approved accrediting service.
3. Seminar registration fees will be
determined by the Seminar Committee, based upon the estimated or projected
costs of the entire meeting. The seminar committee should take in account the
previous year's average attendance, the present average prices of the venue to
set reasonable limits. (Projected costs should never include Vendors promised
funds unless the checks are in hand and availability verified by our Treasurer).
Cancellation
fees will be published in the registration brochure.
4. Registration for the seminar and one-half
(1/2) hotel room cost for two (2) nights will be provided for no more than six
members of the Seminar Committee.
5. Should the need arise, three people shall
have meals and the cost of one-half (1/2) hotel room each paid from the seminar
account if they have to report one day prior to the seminar for set up. Meals, excluding alcoholic beverages, will be
reimbursed up to $50.00 per person for that day. All receipts must be submitted to the Seminar
Chairperson for reimbursement.
6. Reasonable expenses incurred by the
Seminar Committee will be paid from the seminar account. Legible receipts (preferable duplicates) must
be submitted to the Seminar Chairperson for reimbursement.
7. Faculty members will receive complimentary
registration and may attend any part of the seminar.
8. Faculty expenses will be paid from the
seminar account.
9. The Seminar Committee books are subject
to an audit as authorized by the Board of Directors. Unreasonable, or
outlandish spending is not considered acting in good faith on the behalf of the
organization and can used for grounds for member/ committee censure and or legal remedy .
10. A final compilation report of financial
activity will be forwarded to the GAPAN treasurer following the closing of the
seminar account each seminar cycle.
Effective Date: September,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to define the function of the Bylaws, Policy & Procedures Committee.
Responsibilities:
1. Review the Bylaws and Policy &
Procedures annually.
2. Submit recommendations for changes to the
Board of Directors.
3. Revise Bylaws and Policy & Procedures
as approved by the Board of Directors.
4. The President -Elect is responsible for
submitting the updated GAPAN Bylaws/ Policies and Procedures to the the ASPAN secretary per ASPAN Policy #03-550
“Component Bylaws”.
Effective Date: September,
2003, Revised April 09
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to define reimbursement procedures for the President, President-Elect or
Designee(s) when representing GAPAN in their official capacities.
Procedure:
1. The
President and President-Elect represent GAPAN at the annual ASPAN
conference. The President or Designee will
attend other functions as approved by the Board of Directors.
2. Total expenses shall not exceed one-half
(1/2) the money in the State Treasury.
3. Expenses to be paid through the State
Treasury for the ASPAN National
Conference shall include:
a. Competitive
and most economical travel expenses, including airport transfer
b. Conference
registration
c. One-half
(1/2) hotel room fees for five (5) nights
d. Meals,
excluding alcoholic beverages, up to $50/day for six (6) days
4. Expenses to be incurred by the President
or Designee(s) while representing
GAPAN at other functions shall be
approved by a quorum vote of the Board of
Directors prior to the event.
5.
Any approved mileage will
be paid at the current IRS rate.
6.
Receipts for expenses must be submitted to the Treasurer to be
reimbursed.
Effective Date: August,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to define reimbursement procedures for the Executive Board, Newsletter Editor,
Website Editor, Research Chair and
Historian when attending the GAPAN Annual State Seminar.
Procedure:
1. The registration fee will be waived for
the Executive Board, Newsletter Editor, Website Editor, Research Chair, and
Historian. These individuals are
responsible for filling out and returning the appropriate registration forms.
2. One-half (1/2) hotel room cost for two
nights shall be paid from the state fund for the Executive Board, Newsletter
Editor, Website Editor, Research
Chair and Historian. These individuals are responsible for making
their own hotel reservations.
3. Hotel receipts must be submitted to the
Treasurer to be reimbursed.
Effective Date: September,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to determine GAPAN dues and District distribution.
Procedure:
1. GAPAN membership dues will be $30 per
year . Membership dues will be reviewed annually and changed as necessary at
the discretion of the BOD to keep the organization financially sound.
2. Two-thirds (2/3) of the dues will remain with
the State Treasury and one-third (1/3) will be distributed to the District.
3. The Membership Chair will provide the
Treasurer with the membership totals for each District.
4. The Treasurer will distribute the
District dues to each District President.
Effective Date: September,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to define the responsibilities of each District.
Procedure:
1. The District President or President-Elect
shall represent the district at each BOD
meeting.
2. The President of each District shall
serve as the official correspondent with GAPAN.
3. Names, addresses and phone numbers of new
officers are to be sent to the State Secretary.
4. District reports are submitted to the
Secretary and the Newsletter/ Website Editor at each Board of Directors
meeting. If a representative is unable
to attend, then a printed report should be (e) mailed to the State Secretary.
5. Each District shall donate a door prize
for the State Seminar equivalent to 50 dollars.
GAPAN Awards
Effective Date: September,
2003, Revised April 09, July 11
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to establish criteria for the GAPAN/GSA PeriAnesthesia Nurse Scholarship
award. This award is given to recognize
and support excellence in perianesthesia nursing practice. The partnership between the Georgia
Association of PeriAnesthesia Nurses and the Georgia Society of
Anesthesiologists evidences the dedication of both organizations in the pursuit
of continuing education and clinical excellence in perianesthesia nursing.
Purpose
1
To
recognize the contribution and dedication to the field of perianesthesia
nursing by an individual.
2
To
provide an opportunity for education of a dedicated nursing professional.
Registered
Nurses from any phase of perianesthesia nursing who meet the following criteria
are eligible for the scholarship. The
applicant must:
1
Be
currently employed in perianesthesia nursing with a minimum of 2 (two) full
years experience in any phase of perianesthesia nursing.
1
Be
an active member of ASPAN and GAPAN for the past 2 (two) full years prior to
the application deadline.
2
Not
be a current member of GAPAN’s Executive Board of Directors at the time of the
application.
3
Not
be a previous GAPAN Perianesthesia Nurse of the Year recipient.
Process
1
The
applicant will provide to the board an application packet for review prior to
the GAPAN annual state conference.
2
The
applicant will provide evidence of required data and application will meet a
minimum standard of 75 points to be eligible for consideration.
1
The
Executive Board of GAPAN will review and evaluate the applications and select
the scholarship recipient using an objective point system.
2 The
scholarship recipient will be announced at GAPAN’s State Seminar.
3 The
decision of the Executive Board is final.
GAPAN/GSA PERIANESTHESIA NURSE SCHOLARSHIP –
CONTRIBUTION TO PERIANESTHESIA NURSING
Points
are earned for each activity met.
Activities marked with an * are required for the application to be
considered. You are NOT required to meet
all activities.
|
Points earned |
Activity |
Examples of how to meet activity |
Required supporting documentation |
|
10
|
* Letter of
recommendation from nurse manager, coworker or physician. (Cannot be
submitted by a member of GAPAN’s current Executive Board.) |
Letter must state
how the applicant serves as a clinical expert and resource person. |
Typewritten letter. |
|
10
per activity |
Unit specific
perianesthesia clinical activity directed by nurse manager completed
within 5 years. |
Participates in
performance improvement project, writes/revises clinical policies/procedures,
active in unit practice committee, etc. |
Document specific
examples of perianesthesia clinical activities and your role. Must be validated by your manager. |
|
10
per topic |
Presentation of a clinical
topic completed within 5 years. |
Topic must be
applicable to perianesthesia nursing, any format or venue. Excludes ACLS, PALS, and BLS. |
Provide typed
outline or lesson plan. |
|
10 |
Cross trained to
another perianesthesia area of practice. |
Can work in more
than one area: Phase I PACU, preadmission
testing, pre-op, or Phase II PACU. |
Provide names of
areas. Must be validated by your
manager. |
|
10 |
Preceptor for new
employees with a preceptorship completed within 5 years. |
Acts as
preceptor/mentor for new employees. |
Must be validated by
your manager. |
|
1
per Contact hour |
*Attends continuing
education activities within the last year (August 1 – August 30). Minimum of 10 contact hours
must be completed. |
Excludes college
credits. |
Provide a copy of
the contact hour certificate(s). |
|
3
per specialty |
Instructor of
specialty certification course. |
ACLS, PALS, BLS
instructor. |
Provide copy of
current instructor card(s). |
|
5 |
*Active member of
local GAPAN district. |
Regular attendance
and active participation in local district. |
Must be validated by
a district officer. |
|
5 |
GAPAN district
officer/ committee chair or co-chair. |
President, Vice
President/President Elect, Secretary or Treasurer of district, or committee
chair or co-chair. |
Include in CV. |
|
3 |
GAPAN district
committee member |
Active member of
district committee (excludes chair/co-chair. |
Include in CV. |
|
10 |
GAPAN state officer. |
Executive Board,
Member at Large, Editor, or Historian. |
Include in CV. |
|
2 |
Pursuing Bachelors
degree in nursing |
|
Provide copy of
transcript. |
|
5 |
Bachelors degree in
nursing |
|
Include in CV. |
|
3 |
Pursuing Masters
degree in healthcare field. |
|
Provide copy of
transcript. |
|
8 |
Masters degree in
healthcare field. |
|
Include in CV. |
|
5 |
ASPAN committee
member within the last 3 (three) years. |
Any ASPAN committee. |
Include in CV. |
|
5 |
GAPAN state
committee member. |
State seminar
committee, bylaws committee. |
Include in CV. |
|
7 |
Chair of GAPAN state
committee. |
State seminar
committee, bylaws committee. |
Include in CV. |
|
5 |
Published in state/national
perianesthesia newsletter within 10 years. |
ASPAN’s Breathline
or GAPAN’s Awakener or an
edition of an ASPAN Specialty Practice Group newsletter. |
Provide a copy of
the article. |
|
10
|
Published in a
national journal – must be perianesthesia related- within 10 years. |
JOPAN or
other nursing journal. |
Provide a copy of
the article. |
|
10
points each |
CPAN and/or CAPA
certified. |
|
Provide a copy of
card(s). |
Name and
Credentials _________________________________________________
Address
____________________________________________________________
Telephone
(home) __________________ Telephone (work) ___________________
Email
address ________________________________________________________
Perianesthesia
Nursing Experience:
Employer
___________________________________________________________
Address
____________________________________________________________
Position
_______________________ Date of Hire ___________________________
Supervisor
Signature __________________________________________________
Falsification or failure
to follow all instructions will disqualify this applicant.
1
The following
information must be submitted:
1. A completed application form.
2. A copy of your ASPAN membership card.
3. A brief CV – no more than three pages – include
professional experience, education level, and participation in state or
national nursing organizations.
4. Supporting documentation of your contribution to
perianesthesia nursing. (See next page for Activity Verification form, may be
duplicated.)
5. Provide two (2) copies of all of the above
information to a current
State Board member.
DEADLINE: Prior to the Board of Director’s Meeting, the Friday of State Conference– see conference brochure for details. NO EXCEPTIONS.
ACTIVITY VERIFICATION
I verify that
_____________________________ has conducted the following activity:
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Supervisor/District Officer
Signature Telephone
Number Date
------------------------------------------------------------------------------------------------------------
I verify that
_____________________________ has conducted the following activity:
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Supervisor/District Officer
Signature Telephone
Number Date
------------------------------------------------------------------------------------------------------------
I verify that
_____________________________ has conducted the following activity:
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Supervisor/District Officer Signature Telephone Number Date
Effective Date: September,
2003, Revised April 09, Jan 10
Policy Statement: It
shall be the Policy of the Georgia Association of PeriAnesthesia Nurses (GAPAN)
to establish criteria for the GAPAN Recruiter of the Year award. This award is given to recognize recruitment
of GAPAN membership.
Procedure:
1. The GAPAN Recruiter of the Year will be
awarded to the member with the highest number of recruits as certified by ASPAN
from September 1 through August 31.
2. The winner will be announced each
September at the State Conference.
3.
The
winner receives a one-year ASPAN/GAPAN membership/award.
I,
________________________________________, give the Georgia Association of
(Print Name)
PeriAnesthesia
Nurses permission to print my article:
__________________________________________________________________
(Title of
Article)
in
the newsletter The Awakener or on the GAPAN Website. I also warrant that the article contains no
material the publication of which would violate any copyright, personal,
proprietary or other right.
______________________________________
________________
(Signature) (Date)
Form
# 06-100
Original
9/03