Associate Member Submission Form

Unlock Growth Opportunities by Becoming an Associate Member!
Please complete the following form to apply for Associate Member status and take your business to the next level with a world of benefits, including enhanced visibility, networking opportunities, and exclusive offers!
VNA offers a host of benefits:
- Visibility: Elevate your company's online presence with the inclusion of your company profile, logo, and live link on the VNA website ensuring that nurses can easily discover and engage with your offerings.
- Networking Opportunity: Attend local chapter meetings and connect with VNA member nurses, creating potential avenues for sales and new clients.
- Promotion: Through member publications, VNA will promote your company boosting your recognition among nursing professionals.
- Exclusive Offer: As an Associate Member, you'll receive a $300 discount on a VNA Fall Conference exhibit table - an opportunity you won't want to miss!
Cost: $500/Annually
Business Information
Business Name*
Type of Business*
Business Website*
Years in Business*
Contact Information
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I am also the person to contact for invoicing.*

YesNo (additional information will be needed below)
Preferred Payment Method
Please select your preferred method of payment.*

Credit CardCheck
Additional Contact for Invoicing

First NameLast Name
Additional Email for Invoicing
example@example.com
Additional Phone Number for Invoicing
Please enter a valid phone number.
Why do you want to become a VNA Associate Member? (Briefly describe your objectives, goals, and how you plan to engage with the nursing community?*
Terms and Conditions*

I agree to abide by the VNA Associate Membership terms and conditions.I understand that Associate Members do not have voting rights within VNA or ANA.The contact mentioned above will receive an invoice from VNA's bookkeeper within 2 weeks of VNA receiving the submission.
Should be Empty:

Unlock Growth Opportunities by Becoming an Associate Member!

Business Information

Contact Information

Preferred Payment Method