ACNN - Application for Membership

ACNN Application for Membership

Annual dues are $75.00. Dues can be paid either online via PayPal or by mailing a check.

Annual membership dues are payable on your anniversary date. (for October-September).

Please note that you must include a valid email address.

You will not have access to the member's only area of the ACNN website until your membership dues are processed. Once processed, you will receive an email with your login information.

First Name, Middle Initial:

Last Name:

Credentials:

(PNP, CNS, BSN, RN, etc.)

State(s) in which currently licensed:

Institution:

Work Address

Address:

City:

State:

Postal Code:

Home Address

Address:

City:

State:

Postal Code:

Work Phone:

Home Phone:

Cell Phone:

Fax:

Email 1:

Email 2:

Professional Interests:

Preferred address for mail/communication:

Work Home

Include your name/address
Membership List:

Yes No

Note: By choosing yes, your name may be provided on mailing lists for educational materials

Password:

Verify Password:

Dues Payment Option

Online with PayPal:

Note: You will be redirected to PayPal's site for fullfillment.
You do not need to be a PayPal member, you just need a credit card.

Mail a check to:

Christine O'Dell RN, MSN
32 Roberta Drive
Cortlandt Manor, New York 10567

Make your dues check payable to ACNN .