National League of NursingNational League of Nursing

The Voice of Nursing Education

Membership Application

 

West Virginia League for Nursing Membership Application

New Member: _________ Renewal: _________

NAME/CREDENTIALS: _______________________________________________________________

ADDRESS: _________________________________________________________________________

CITY/STATE/ZIP: ____________________________________________________________________

PHONE: __________________________________________________________________________

E-MAIL: ___________________________________________________________________________

EMPLOYER: ________________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY/STATE:________________________________________________________________________

PHONE: _________________________________________________________________________

E-MAIL: __________________________________________________________________________

POSITION: _________________________________________________________________________

PREFERRED ADDRESSES FOR MAIL OR E-MAILS? HOME: _______ WORK: _____

Remember: All monies are due by the date of the Annual Program

Check appropriate line below:

________I wish to join the WVLN as a Nurse Educator

________I wish to join the WVLN as a Consumer

________I wish to join the WVLN as a Community Nurse

________I wish to join the WVLN as a (please specify) ______________________

Dues (Only) $50.00

Contribution: ________

TOTAL Enclosed: ________ (Make check payable to WVLN)

SIGNED: __________________________________________________DATE:___________________

In addition, if you have any suggestions for presenters or topics for our Faculty Development Programs we would appreciate hearing what they are: ________________________________________________________________________

We look forward to your active membership in this worthwhile organization.

Please mail application and dues to:
Nancy Brumfield, RN, MSN
St. Mary’s Center for Education
2900 1st Ave
Huntington, WV 25702