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Membership Application

West Virginia Nurses Association State Only Membership

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  • Join Online. To join West Virginia 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 West Virginia Nurses Association .

    (Please note: This membership is for the West Virginia 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 - $149.00, or $12.92/month
  • Required Fields. Fields marked (* ) are required
  • General Information (Address information for billing purposes only)
    Join State: WEST VIRGINIA
    First Name:
       Middle Initial:
    Last Name:
    Home Address:
    City, State, Zip
    E-mail Address:
    Home Phone:
    Preferred Contact: Home Phone    Work Phone
       Home Fax:
       Gender: Female    Male
    RN License Information
    RN License Number:
    License State:
    Employer Information 
       Employer Name:
       Employer Address:
       City, State, Zip
       Work Phone:
       Work Fax:
    Professional Information
       Employment Status:
       Position Title:
       Type of Work Setting:
       Clinical Practice Area :



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