WSNA Resolution Submission

Primary Author *

First Name

Last Name

Membership Expiration Date *

MM

DD

YYYY

Phone Number *

(###)

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Phone Number for Texts / SMS

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you agree to have your name and email posted publically so that those interested in your topic can contact you? *

Yes

No

Faculty Advisor / State Advisor *

First Name

Last Name

Faculty Advisor / State Advisor Phone Number

(###)

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Second Author (if applicable)

First Name

Last Name

Second Author Phone Number (if applicable)

(###)

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Second Author Membership Expiration Date: (if applicable)

MM

DD

YYYY