Become a Member or Renew Your Support!!

For information on membership benefits, please click here:

http://www.nbna.org/index.php?option=com_content&view=article&id=72&Itemid=69

First Name: 
Middle Name: 
Last Name: 
HRCI Status: 
Job Title: 
Preferred Email: 
Password: 
Confirm Password: 

Personal Contact Information:
Alternate Email: 
Home Address: 
Apt/Suite: 
City: 
State: 
Zip: 
Home Phone: 
Home Fax: 

Company Information:
Company: 
Description: 
Website Address: 
Address: 
Apt/Suite: 
City: 
State: 
Zip: 
Phone: 
Fax: 
-Category * (required)    
      
Nursing License # (if applicable)     
      
Type * (required)    
      
Are you a new member or renewing your membership? * (required)    
      
If new member, please indicate how you were recruited: * (required)    
      
If other, name of person who recruited you:     
      
Membership Type* (required)    
     $70 - Student Nurse ($55 National + $15 Local)
$150 - Retired/1st Year Grad ($125 National - $25 Local)
$235 - RN, LPN or LVN ($200 National - $35 Local)
$2000 - Lifetime Membership Dues
  

(Fees include both National and Local Chapter dues)
If lifetime membership, enter year it was paid in full:     
      
Specialty * (required)    
      
If specialty not listed above, select other and provide name here:     
      
Total:    
    $

 


For Membership Information email us at: info@coloradoblacknurses.org


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