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Membership Type Membership Type STUDENT-Unlicensed nursing student who is enrolled in a nursing program, college or school of nursing. ASSOCIATE--Community member who supports the vision, mission and goals of HNA. Associate members may not vote but are eligible for benefits of HNA. ACTIVE-(RN/LPN/LVN) all registered and licensed RNs, LPNs, and LVNs who are in good standing with the licensing agency of their state or territory. Active members are entitled to all privileges and benefits of membership.

Other

First Name

Last Name

Date Of Birth

Email Address

Applicant Phone (Mobile number is required for Text Messages)

Confirm Email Address

Applicant Address

Applicant City

Applicant State

Applicant Zip Code

Employer Information Employer Information

Employer Name (if applicable)

Employer Address

Employer City, State

Employer Zip Code

School Information (if applicable) School Information (if applicable)

School Name

School Address

School City, State

School Zip Code

Student Document Verification Upload documents here for STUDENT Membership Choose FilesNo file chosenAccepted file types: jpg, jpeg, jpe, gif, png, pdf, doc. Max. file size: 1 MB

Current Profession (if applicable) Current Profession (if applicable)

Current Title/Credentials/Highest Degree

Years of Experience Current Title

Clinical Area

RN/LPN/LVN License Number

Licensed State/Territory

Licensed Expiration Date

I am a: I am a: New Member Former Member

*If no Chapter is available near you, you will automatically be registered as a Member-at-Large (MAL)* *If no Chapter is available near you, you will automatically be registered as a Member-at-Large (MAL)* Fresno Sacramento Twin Cities Wisconsin Member At Large (MAL)

Memo for HNA Team: Memo for HNA Team:

Acknowledgement Acknowledgement I confirm that everything contained in this application is true and correct to the best of my knowledge. If accepted, I hereby agree to abide by the Bylaws of HNA and will uphold the vision and mission of HNA to its highest standards.