Student Membership Form
Greater New York City Black Nurses Association
To become a member, please take the time to fill out the information below. If you are an RN, please complete the General Membership Application Form.
I am a:
*
Renewing
New
I am:
*
Student
Do you have an RN license?
Yes
No
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Name
*
First Name
Last Name
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
School
*
Gender:
*
Male
Female
Non-binary
Highest Degree Held
*
Associate Degree
Baccalaureate in Nursing
Another Baccalaureate
Master's in Nursing
Another Master's
Doctorate in Nursing
Other
Professional Organization Membership
American Nurses Association
American Association of Critical Care Nurses
National League of Nursing
Chi Eta Phi
American Public Health Association
American Academy of Nursing
Other
Age: (Will Remain Confidential)
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Please upload a copy of your nursing school acceptance letter or class schedule.
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Student Membership Dues
National and Local Dues
$
45.00
Kindly utilize Zelle to send your payment to
gnycbna@gmail.com
Have you completed your Zelle payment successfully? If yes, please click "Yes."
*
Yes
Please upload proof of payment.
*
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