Memorial Request Form

Memorial Request Form

ENA will honor members during a special memoriam presentation held annually at the annual Emergency Nursing conference. If you would like to recognize a member who has died, complete the following information as it relates to the member. All requests and photos must be submitted by August 15 to be included in the memoriam presentation.

Complete the following information as it relates to the ENA member who has passed away

Note: this information will be used when developing the presentation. Although all information may not be used due to space limitations, be sure to include as much information as possible. Please avoid submitting links to obituaries.

Full Name

Credentials

State Council

Chapter (if applicable)

Was the member's death related to the COVID-19 pandemic?

Yes

Positions Held

Positions held at the national, state and/or chapter level (please include years if known, i.e. Dallas ENA Chapter, 2014 President; Montana ENA State Council, 2013 Treasurer)

Professional Accomplishments (limit up to three)

Personal Accomplishments (limit up to three)