Transcultural Nursing Society(TCNS)

PETITION TO BECOME A REGIONAL LIAISON OR COOPERATIVE ALLIANCE

"That the culture care needs of people in the world will be met by nurses prepared in transcultural nursing."
Madeleine Leininger

REGIONAL LIAISON INFORMATION

Application for:
Organization Name:
Region to be Served:
Date:
Title: First Name:
Last Name:
Credentials:
Mailing Address Line 1:
Mailing Address Line 2:
Mailing City:
Mailing State/Province:
Mailing Country:
Mailing Zip Code:
Contact Email:
TCNS Member Number:
Organization website:

COOPERATIVE ALLIANCE INFORMATION

Geographic borders of chapter by region – city, state, country:
Will Cooperative Alliance be associated with an Organization:
If yes, please list Organizaiton Contact Information:
Mailing Address Line 1:
Mailing Address Line 2:
Mailing City:
Mailing State/Province:
Mailing Country:
Mailing Zip Code:
Contact Email:
Contact Phone:
Organization website:

For Cooperative Alliance Applicants: Please describe below the nature of the cooperative alliance and expectations. For Regional Liaison Applicants: Please describe experience with TCN and how you will share this information if contacted.

Additional Information

Signature:

Click continue to review your petition to become a regional liaison or cooperative alliance before submission: