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NBNA Membership Application
I am:
*
Renewing
New
I am a:
*
RN
LVN/LPN
Retired Member
First Year Graduate
First Name
Credentials
City:
Zip Code:
Email
State Issued:
Last Name
Address:
State
Phone:
Nursing License#:
Work Affiliation:
Recruited by:
Experience in Nursing
*
Less Than 2 years
2-5 years
6-10 years
11-15 years
16-20 years
More than 20 years
Level of Care Provided:
*
Inpatient
Outpatient Ambulatory
Public Health Department
Nursing Home
Residential
Rehabilitative
Nurse Profile:
ANA Certified
Generalist (RN, C)
Specialist (RN, CS)
Prescriptive Authority
Primary Work Setting:
*
Private Non-Profit Hospital
Public/Federal Hospital
Private, Investor-Owned Hospital
School/College of Nursing
Independent/Private Practice
Military
Industry
Home Health Agency
Behavioral Care Company
HMO Community Agency
Research
Nursing Home
Nursing Specialty
Nursing Employment:
*
Full-Time
Part-Time
Retired
Unemployed
Primary Role:
*
Adm/Dir/VP of Nursing
Nurse Manager
Assistant Nurse Manager
Adv Practice Nurse
Researcher
Consultant
Educator
Case Manager
RN
LPN/LVN
Professor
Associate Professor
Assistant Professor
Staff
Gender:
*
Male
Female
Other
Highest Degree Held:
*
Associate Degree in Nursing
Bachelor of Science in Nursing
Another Baccalaureate
Master of Science in Nursing
Another Master's
Doctorate in Nursing
Other
Professional Organization Membership:
American Nurses Association
American Association of Critical Care Nurses
National League of Nursing
Chi Eta Phi
American Public Health Association
American Academy of Nursing
Other
Age: (Will Remain Confidential)
*
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Annual Salary (Will Remain Confidential)
*
UNDER - $20,000
$20,000 - $29,000
$30,000 - $39,000
$40,000 - $49,000
$50,000 - $59,000
$60,000 - $69,000
$70,000 - $79,000
$80,000 - PLUS
Membership Dues
$210 RN
$175 LVN/LPN
$150 Retired
$200 1st Year Grad
Enter the amount you wish to pay:
$
Proceed to Payment
Thanks for submitting!
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