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Membership Application

Pennsylvania State Nurses Association State Only Membership

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  • Join Online. To join Pennsylvania State Nurses Association State Only Membership online, you must fill out the form below, enter your credit card information and submit it electronically via our secure server. Your order will be sent to the American Nurses Association and processed by the ANA's Membership Billing Department on behalf of the Pennsylvania State Nurses Association .

    (Please note: This membership is for the Pennsylvania State Nurses Association only and does not include membership in the American Nurses Association. If you would like to join both your C/SNA and ANA, please go to ANA & State Membership Application to join.)
  • Membership Dues - Please select one:

    State Only (First Year Introductory Rate) $150.00, or $13.00/month
    State Only (Renewal or Reinstatement) $170.00, or $14.71/month
  • Required Fields. Fields marked (* ) are required
  • General Information (Address information for billing purposes only)
    Join State: PENNSYLVANIA
    First Name:
       Middle Initial:
    Last Name:
    Credentials:
    Home Address:
    City, State, Zip
       
    E-mail Address:
    Home Phone:
    Preferred Contact: Home Phone    Work Phone
       Home Fax:
       Ethnicity:
       Gender: Female    Male
    RN License Information
    RN License Number:
    License State:
    Employer Information 
       Employer Name:
       Employer Address:
       City, State, Zip
       County:
       Work Phone:
       Work Fax:
       Year Entered
       the Profession:
       How did you hear
      about PSNA?
    Professional Information
       Employment Status:
       Position Title:
       Type of Work Setting:
       Clinical Practice Area :

         

     


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