New York Black Nurses Association, Inc. Membership Application Form 2025

New York Black Nurses Association, Inc. Membership Application Form

New York Black Nurses Association (14) Dr. Theresa Lundy, President PO Box 3635, Grand Central Station New York, New York 10163 Ph: (718) 902-2131;E-Mail: info@nybna.org
Date of Application*

MonthDayYear
Date
Membership Status*

New MemberRenewed MemberReclaimed Member
Full Name*

First NameLast Name
Nursing License

License Number State
Year Joined NYBNA:
I am a:*
Lifetime Member Year Joined if applicable:
Nursing Credentials
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Work Affiliation/School Attending :
Experience in Nursing

Less than 2 Years2-5 Years6-10 Years11-15 Years16-20 YearsMore than 20 Years
Level of Care Provided
Nursing Specialty i.e. ER, OR
Nurse Profile
Primary Work Setting
Nursing Employment
Primary Role
Highest Degree Held

1. Associate Degree2. Baccalaureate in Nursing3. Another Baccalaureate4. Master’s in Nursing5. Another Master’s6. Doctorate in Nursing
Gender
Age Range (Response will be kept confidential) *
Salary Range (Response will be kept confidential)*

Under $30,000$30,000 - $49,999$50,000 - $69,999$70,000 - $89,999$90,000 and above
I must submit both membership application and payment (ONLY to New York BNA as indicated below) to be an active member in good standing.*

I understand
METHOD OF PAYMENT: Please make payment with application submission

Make Zelle payment to NYBNASALES@GMAIL.COM Or Make Check Payable to New York Black Nurses Association
My Products
prevnext( X )
RN (National $160 + Local $50)
$210.00



Retired (National $100 + Local $25)
$125.00



1st Year Graduate (National $150 + Local $12.50)
$162.50



Student Unlicensed (National $35 +$12.50)
$47.50



Lifetime Members Local Dues Only. Click dropdown to select 1 of 3 options below (RN/LPN/LVN/Retired):
$25.00 Lifetime Member Local Dues Only



Become a New Lifetime Member. 6 installments of $515 plus local dues of $50
$565.00



Total

$0.00
Should be Empty:

New York Black Nurses Association, Inc. Membership Application Form

METHOD OF PAYMENT: Please make payment with application submission