Name
Street Address
City
State
Zip Code
Work Phone
Home Phone
Fax Number
E-mail

School of Nursing/ Undergrad.School

Class of    Degree/ Cert.

 

Graduate School

Class of    Degree/ Cert.

 

Other Education

Class of    Degree/ Cert.

 

Sex: Select One Female Male    Race/Ethnicity: Select One Caucasian African American Hispanic Asian Multi-Ethnic

                 Other Race/ Ethnicity:     

Age:                                       Member Status:

18-34        50-64            New Member

35-49        65+               Returning Member

Date of Birth:  Month Select One January February March April May June July August September October November December   Day Select One 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  

To view descriptions of each committee click the link below:

MCNBNA Committees

(Served = S; or Interested=I)

R.N./L.P.N                     $ 200.00
Retired Nurse                $  95.00
New Graduate               $  95.00   (Non-Licensed)

Student                         $  50.00

Membership dues are paid annually and arrangements can be made for dues to be paid in installments, but membership is obtained when entire amount is received.

Please make check or money order to: MC-NBNA

Mail payment to:     MC-NBNA Treasurer

                      P.O Box 16649

                                        Milwaukee, WI 53216-0649

(Please include how you would like to be contacted i.e. email, phone, etc.)