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Membership Application
Member Information
*

Prefix
First Name
Last Name
Suffix
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*

*




Month and day
Experience & Education
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*

*

(Note: A student nurse (SN) is an unlicensed student in a nursing program)
*


Please enter using YYYY format, e.g., 2024
*

Please select all that apply.

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Volunteer
You have a great opportunity to be involved with the organization.

Please select all the committees you are interested in.

Please list.
Annual Membership Dues
(Memberships are free for nursing students pursuing their initial RN degree.)