New Orleans Black Nurses Association
Mary L. Kelly, President
Membership
New
Returning
Lifetime
If Lifetime, year you joined
-
Month
-
Day
Year
Date
I am a:
RN (Membership fee $250.00)
LPN/LVN (Membership fee $215.00)
Retired member (Membership Fee $165.00)
1st Year Grad (Membership fee $177.50)
Student (Membership fee $70.00)
Name
First Name
Last Name
Credentials
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Nursing License #
Work Affiliation
Recruited by
Age Range
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65 plus
Experience in Nursing
0 (Unlicensed)
Less than 2 years
2 - 5 years
6 - 10 years
11 - 15 years
16 - 20 years
More than 20 years
PRIMARY WORK SETTINGS
Private Non-Profit Hospital
Public/Federal Hospital
Private, Investor-Owned Hospital
School/College of Nursing
Independent/Private Practice
Military
Industry
Home Health Agency
Behavioral Care Company/HMO
Community Agency
Research
Nursing Home
PRIMARY ROLE
Adm/Dir./VP of Nursing
Nurse Manager
Assistant Nurse Manager
Adv Practice Nurse
Researcher
Consultant
Educator
Case Manager
RN
LPN/LVN
Professor
Associate Professor
Assistant Professor
Staff
HIGHEST DEGREE HELD
Associate Degree
Baccalaureate in Nursing
Another Baccalaureate
Master's in Nursing
Another Master's
Doctorate in Nursing
Other
LEVEL OF CARE PROVIDED
In-Patient
Out-Patient Ambulatory
Public Health Department
Nursing Home
Residential
Rehabilitative
PROFESSIONAL ORGANIZATION MEMBERSHIP
American Association of Critical Care Nurses
National League of Nursing
ANNUAL SALARY
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - Above
NOBNA MEMBERSHIP
prev
next
( X )
RN (MEMBERSHIP FEE)
$
250.00
LPN/LVN (MEMBERSHIP FEE)
$
215.00
RETIRED MEMBER (MEMBERSHIP FEE)
$
165.00
1st YEAR GRAD (MEMBERSHIP FEE)
$
177.50
STUDENT (MEMBERSHIP FEE)
$
70.00
Credit Card
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform