Member Spotlight Form – Ohio Chapter Your Name(Required) First Last Your Credentials(Required)Your Email Address(Required) Email Address Confirm Email Address Your Phone(Required)What is Your Membership Status? (select one):(Required)*Membership Types: https://www.napnap.org/membership-choices/ Member (Preferred, Essentials, or Retiree) Student Member (Career Starter/Student) I am NOT a member Are You Spotlighting Another Person?(Required) Yes No If “yes,” what is the name AND credentials of the person you’re spotlighting?What is the membership status of the person you are spotlighting? (select one):*Membership Types: https://www.napnap.org/membership-choices/ Member (Preferred, Essentials, or Retiree) Student Member (Career Starter/Student) Unsure (person being spotlighted must be a current member of the Ohio Chapter) Not Applicable Spotlight Yourself or Another MemberPlease write a short paragraph about yourself (or another member) using one or more of the prompts above:Member Spotlight:(Required)Multi-File UploadPlease upload a photograph of yourself or the member you are spotlighting. Alternatively, you may upload an image or document with the requested information. Drop files here or Select files Max. file size: 50 MB. Privacy and Consent(Required)Privacy and Consent: By submitting this form, you confirm that you agree to the storage and handling of the provided information and photographs by the Ohio Chapter of the National Association of Pediatric Nurse Practitioners. You grant permission (or are authorized to grant permission) for the use and reuse of any photographs, images, and information submitted, as outlined in the Terms of Use. I agree to the privacy and consent policies.PhoneThis field is for validation purposes and should be left unchanged.
