2024 Membership Application Form

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2024 Membership Application Form

*Please note - many institutional emails are not compatible with outside applications like our membership portal and google classroom. Please consider using your personal email. Otherwise, you may have to add your institutional email to a Google account in order to access the classroom.

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* Indicates required question

Email *

Your email

First Name *

Your answer

Last Name *

Your answer

Professional Designation (Example: RN, NP, RPN, LPN, ect. Enter associate or student) *

Your answer

Nursing Regulatory Body License # (Enter 0000 if you are not a nurse or are a student) *

Your answer

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