21 Jul 2022 Name *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone (H)Phone (W) *Phone (C) *Email *Current License # *State *Exp *Membership Status *NewRenewingDate of Birth *Licensed *APRNRNLPN/LVNStudentRetiredAs part of your membership, you are expected to participate on at least one of the following committees: *FinanceMembershipBy-lawsProgramHealth PolicyScholarship & AwardsPublicity & Public RelationsHospitality (Special)Nursing Education (Special)Nominating (Elected)Community Liaison (Special)Communication (Special)Chapter Development (Special)Membership Dues/Annual:RN/ARNP: $235.00 (National dues $225.00)LPN/LVN: $200.00 (National dues $125.00)Retired: $125.00 (National dues $100.00)1st Year Grad: $175.00 (National dues $150.00)Students: (Unlicensed) $45.00 (National dues $35.00)Life-Time Membership: $2075.00 (National dues $2,000.00) Annual Membership Dues: Dues includes the National & Local ChapterLocal Dues: $75 Renewal Due Date is 12/31/2022All dues expire on 12/31 of each year. Membership dues are tax-deductible.*Donations are accepted.WebsiteSubmit
