MCSNA Membership Application Form 2024-2025

MCSNA Membership Application Form for 2024-2025

Welcome!

To join MCSNA, please fill out the form below.

Guidelines:

Registration for membership opens July 1, 2024.
You may apply for membership at any time; however:
- Your annual membership will expire at the end of the school year.
- This form (and if applicable, your payment for your Membership) must be received by September 30, 2024 in order for your information to be included in the 2024/2025 directory.
Membership is not complete until payment has been received (unless you are retired).

Name*

First NameLast Name

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Number*

Area CodePhone Number

Preferred Email*

example@example.com

School District & School*

District- [School] [School Address]

Work Number*

Area CodePhone Number, include Extension if applicable

Fax Number

Area CodePhone Number

Work Email*

example@example.com

Certification Information*

My NJSN certification was completed at the following college or university

Certificate Year (or Expected)*

Membership in the Association shall be in the following categories:

Section 1. Regular

All members in this classification shall possess a current license to practice as a Registered Nurse in the State of New Jersey and a current New Jersey School Nurse Certificate.
They must be currently employed in Morris County as a school nurse or a school nurse supervisor, or have their primary assignment, the administration, education or the provision of school health services.
Annual dues shall be specified by the Executive board and voted upon by the regular membership.

Section 2. Associate

Associate members shall enjoy the privileges of the Association, may serve on committees, but shall not vote or hold office. Any registered professional nurse who is not eligible for Regular Membership shall be eligible for Associate Membership. This may include public health nurses, professors of nursing, students, and retired nurses.
Annual dues shall be less than the amount specified for Regular members.

Section 3. Retired

Members upon retirement shall be eligible for Retired membership. Retired members may serve on committees in an advisory capacity. Retired members shall enjoy the privileges of the Association but shall not vote or hold office.
No dues shall be required.

Are you retired?*

I am retiredI am not retired

Membership is free for retired school nurses. You earned it!

Additional Information*

I would like to serve on the MCSNA Executive Board/CommitteeI am interested in Substitute School NursingI have a current membership in NASNI have a current membership in NJSNANone of the above

Payment Options

You may pay for your Membership by personal check or via PayPal.

Please Note: You do not need to have a PayPal account to pay with PayPal. You may simply use your credit card (MasterCard, Visa, Amex, Discover) with the PayPal option. If you use PayPal, there will be a $2 surcharge due to the fees PayPal bills our association for using its services.

I will be paying by:*

Personal CheckPayPal

Directions for paying by Personal Check

Membership Type you are selecting & fees that are applicable if paying by Personal Check*

Regular Member $35.00Associate Member $20.00

For the amount of your Membership Type selected, please make a personal check out to: MCSNA
Please mail your personal check out to:

Mrs. Jennifer Hirsch
104 Alpine Trail
Sparta, NJ 07871

All Checks must be received by September 30, 2024.
All returned check fees will be the responsibility of the member to reimburse MCSNA.

Paying via PayPal

Membership Type you are selecting & fees that are applicable if paying via PayPal*

Regular Member$37.00

[$35 Membership Fee + $2 surcharge for using PayPal]

Associate Member$22.00

[$20 Membership Fee + $2 surcharge for using PayPal]

Total $0.00

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If you have any questions, please email our 2024/2025 Membership Committee Chairperson, Jessica Seidel @ <jessicaseidelmcsna@gmail.com>.