AMSN Chapter Toolkit - Chapter Charter Petition | Academy of Medical-Surgical Nurses

Congratulations on your decision to establish your own AMSN Chapter Charter!

The Academy of Medical-Surgical Nurses (AMSN) chapters compliment and are a vital component of the National Office. Each local chapter is an important mechanism for recruiting, retaining and encouraging participation in AMSN nationally.

Chapters are a way for local AMSN members to connect with each other to share ideas and to raise awareness of the med-surg specialty.

AMSN chapters are comprised only of AMSN members.

Please fill out the form below to create your own AMSN Chapter:

Fields marked with an asterisk (*) are mandatory.

AMSN MEMBERS ONLY UNDERSTANDING & AGREEMENT

NOTE: Your application will not be considered if the check-box below is not checked.

I understand that all of the people that will make up this chapter are AMSN members with an up-to-date paid membership. *

Yes

BUILD YOUR CHAPTER

What Would You Like the Chapter to be Called? *

You determine what the chapter name will be. If you are stuck for a name, view the Chapter Listings to get some ideas for the chapter name.

INSTITUTION/FACILITY

What institution or facility would you like your chapter to represent? NOTE: your chapter charter does not necessarily have to represent an institution or facility. If not, leave this field blank.

Institution/Facility

LOCATION

Define what locations (cities and/or counties) and state(s) your chapter charter will serve.

City/Cities

Please list the city/cities that you would like your chapter to serve (separate with commas).

County/Counties

Please list the county/counties that you would like your chapter to serve (separate with commas).

State(s) *

Please list the state(s) that you would like your chapter to serve (separate with commas).

Country *

FIVE (5) FOUNDING CHAPTER MEMBERS

List the required five (5) founding AMSN members for this chapter. NOTE: The chapter may have more members, but only five need to be listed here. On the next line, select the chapter officer title associated with each individual. If they are not a chapter officer, select Member. Please note, chapters are not required to have officers and you may select Member for all.

#1a: AMSN Member Name, City, State, Country *

#1b: Select Chapter Officer Title

#2a: AMSN Member Name, City, State, Country *

#2b: Select Chapter Officer Title

#3a: AMSN Member Name, City, State, Country *

#3b: Select Chapter Officer Title

#4a: AMSN Member Name, City, State, Country *

#4b: Select Chapter Officer Title

#5a: AMSN Member Name, City, State, Country *

#5b: Select Chapter Officer Title

DESIGNATED CHAPTER CONTACT PERSON/SPOKESPERSON

The designated chapter contact/spokesperson will receive ALL communication regarding the chapter, including email, traditional mail, phone calls, etc. The chapter contact/spokesperson does not need to be one of the five founding members, but, must be an AMSN member.

Name *

Email *

Address *

City, State, Country, Zip *

Best Phone Number to be Reached *

FUN EXTRAS FOR YOUR CHAPTER LISTING!

If you are not ready to add a picture, or Facebook page, or chapter website listing, don't worry, you can always add them later once your chapter has been accepted and is listed in the AMSN Chapter Listings.

Add a Picture

Consider adding a picture to your chapter listing. It could be a group shot of members, or the primary contact. No cartoons, illustrations, or copyrighted graphics please. Images must be approved by AMSN before they are posted to your chapter listing, and may only be changed every six months. File size may not exceed 500KB. Formats excepted are (.gif), or (.jpg) or embedded into a (.doc), or (.pdf).
Files must be less than 500 KB.
Allowed file types: gif jpg png pdf doc.

Facebook

Note: this Facebook page must only be used for your AMSN chapter. No personal Facebook pages are permitted in your AMSN chapter listing.

Chapter Website

Note: this webpage/website must only be used for your AMSN chapter. No personal webpages/websites are permitted in your AMSN chapter listing.

AMSN CHAPTER CHARTER AGREEMENT

By filling out this chapter petition form, you agree to all of the following: *

•	Assign one designated contact/spokesperson for our chapter.
---------- The designated contact/spokesperson will inform AMSN immediately of any change, including new officers or primary contact.
---------- The designated contact/spokesperson's name and email will be included with the chapter listing on the AMSN Website.

•	Complete at least four (4) chapter activities per year (e.g. social, education, charity).

•	Submit an AMSN Chapter Status Report (read below) annually.

•	Use AMSN member information for chapter business only.

•	Provide notification to the AMSN National Office if our chapter chooses to relinquish its charter.
---------- The primary contact will submit a signed Dissolution Agreement (read below) stating that all financial obligations have been met.
---------- A check for any remaining money will accompany the signed statement.

Chapter Achievement Report | Dissolution Agreement

By submitting your chapter application, you attest that all people named above are up-to-date, paid AMSN members. *

Yes

---> YOUR APPLICATION WILL NOT BE CONSIDERED IF ANY PERSON NAMED ABOVE IS NOT AN AMSN MEMBER.

The "Save Draft" feature allows you to save the information you have entered so far, and come back later (or several times) to finish it. Once you complete filling out your application - and have nothing more to add, click "Submit Your Application." Note, once your chapter has been approved, you can always edit most information in your chapter listing.

Leave this field blank

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Congratulations on your decision to establish your own AMSN Chapter Charter!

Please fill out the form below to create your own AMSN Chapter:

FREE CNE for AMSN Members from the AMSN Online Library!