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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Recruited by:
*
My Products
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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. Please do not attach acceptance letter or school schedule.
*
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Please check your email for your GNYC BNA welcome letter.
*
Yes
Email
example@example.com
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