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Your Name & Pronouns
Name
*
Prefix
First Name
Last Name
Suffix
Nickname
Do you prefer to use a name other than your first name? e.g., a nickname or middle name.
Preferred Pronouns
Contact Information
Please tell us the best way for AAPPN to contact you. The address, email, and telephone numbers you provide in this section will not be shared.
Email
*
This email will be used for all AAPPN emailed communications including newsletters, event announcements, listserv posts, and membership renewals.
Verify Email
*
Mailing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Daytime Phone
*
What is the best number for AAPPN to use to reach you during the day?
Membership & Eligibility
If you are licensed in WA State as a psychiatric nurse practitioner, please join as a Clinical member even if you live in another state. Out-of-State membership is for psychiatric nurse practitioners who are licensed, but not in WA State. For details about membership and eligibility, please visit www.aappn.org and select Eligibility under the Membership menu.
Licensed in Washington State
*
Are you currently licensed to practice as an advanced practice psychiatric nurse in the State of Washington?
Yes
No
NA - I am a student in a PMHNP program
Washington State ARNP License Number
*
Licensed in Another State
*
Are you currently licensed to practice as an advanced practice psychiatric nurse outside the State of Washington?
Yes
No
NA - I am a student in a PMHNP program
State Your License is In
*
Other State ARNP License Number
*
ANCC & Education
*
Check all that apply.
Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan)
Adult Psychiatric and Mental Health Nurse Practitioner
Clinical Specialist in Adult Psychiatric and Mental Health Nursing
Clinical Specialist in Child and/or Adolescent Psychiatric and Mental Health Nursing
Master's or Doctoral Degree in Psychiatric-Mental Health Nursing
Graduate Student in Psychiatric-Mental Health Nursing Program
Since you are licensed in Washington State, please join as a Clinical member. If you are age 65+ or retired, you may join as an Emeritus member regardless of which state(s) are licensed in.
Membership Fee
*
$62.50
-
Clinical
$25
-
Emeritus
$37.50
-
Out-of-State
$12.50
-
Student
Donation Schedule
Quarterly
Graduation Date
*
When do you expect to graduate? If you graduated within the last year, when did you graduate?
Get Involved
Listserv Opt-In
*
Please review AAPPN's Listerv User Guide at https://www.aappn.org/connection/professional-community/listserv-user-guide/
I attest that I have read the Listserv User Guide and agree to its policies.
I do not wish to join AAPPN's Listserv
Join a Special Interest Group
Child, Adolescent, and Young Adult (CAYA) Specialty Group
Rural Practice Group
Case Presentation Monthly Meeting
Other Information
Alma Mater
Where did you receive or will receive your master's or doctoral degree in psychiatric-mental health nursing?
Work Setting
Private Practice
Community Mental Health
Education
Hospital
Other
Other Work Setting
How long have you been an advanced practice psychiatric nurse?
Less than one year or student
1-5 years
6-10 years
11-15 years
16-20 years
More than 20 years