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Your Name & Email
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.
Email
*
This email will be used for all AAPPN emailed communications including newsletters, event announcements, listserv posts, and membership renewals.
Verify Email
*
Membership & Eligibility
If you are licensed in WA State as a psychiatric nurse practitioner, please renew 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
*
Please update if this has changed since last year. 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
*
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.
Member Payment Schedule
*
$62.50
-
Clinical - Quarterly
$25
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Emeritus - Quarterly
$37.50
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Out-of-State - Quarterly
$12.50
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Student - Quarterly
Membership Payment Schedule
Quarterly
Update Contact Information
Update your AAPPN membership record. Please note, this form will not update the information for your profile in AAPPN's provider directory.
Preferred Pronouns
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?
ANCC & Education
Please update if this has changed since last year.
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
Alma Mater
Where did you receive or will receive your master's or doctoral degree in psychiatric-mental health nursing?
Graduation Date
Please update if this has changed since last year. When do you expect to graduate? If you graduated within the last year, when did you graduate?
Get Involved
For details about the following volunteer opportunities, please visit www.aappn.org and select Volunteer under the Connection menu.
Volunteer for a Committee
Get to know your colleagues, build your leadership skills, and support your profession.
Education
Membership
Legislative
Advocacy eGroup
Awards
I'm not sure. Please contact me.
Join an Active Group
Child, Adolescent, and Young Adult (CAYA) Specialty Group
Rural Practice Group
Case Presentation Monthly Meeting
Other Information
Please update if there have been recent changes.
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