Become a member of the NFLPN

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Become a Member of NFLPN

***To join online use the form below

***For print version to mail

Membership Application

Address:ss:				City:		Home Phone Number:
First Name:				Last Name:		PN License #/State:
State:				ZIP:		Work Phone Number:
						Email Address:
Date of Birth:					Referred By:
	month	day	year		Membership No. (if renewing)

1. Are you interested in a leadership position ?				Yes No
2. Are you interested in writing articles for the NFLPN?				Yes No
3. Are you planning on earning an ASN or BSN degree?				Yes No
4. Is your decision to join the result of a call from the NFLPN?				Yes No
Employment Setting (choose one or more of the following)
	Home Health	Long Term Care	Hospital	Private Practice
	Full Time	Part Time	Military	School	Other

State Affiliation
(select a state affiliation or "National Only" from the list)

All states listed have affiliate state associations within NFLPN. All NFLPN Members residing in the states that are not on the list may affiliate with any State Association close to them or simply retain only NFLPN (National Only) membership. Individual, Military and International Members must select "National Only" from the State Affiliation list.

Membership Type
(choose one from the following types)

	Active		Retired		Military		Student
			Affiliate		International		Individual

Or Submit form and pay online now

Semi-annual payment option will be on the next page after the form is completed

National and State Dues Only - Local or District Dues Not Included
Membership type	Annual fee	Description
ACTIVE (Per capita)	$100.00	Active - A practical/vocation nurse who holds a current license issued by any State, Territory or Possession of the United Sates or by any Province or Territory of Canada.
RETIRED	$65.00	Retired - An LP/VN who has achieved retirement age or has retired due to disability may become a retired member with a reduction in annual dues.
MILITARY	$70.00
STUDENT	$25.00	Student - A student enrolled in an approved school of practical/vocational nursing. Renewal of membership as an active member of NFLPN shall be contingent upon having obtained LP/VN licensure.
AFFILIATE	$60.00	Affiliate - Someone who is not a licensed practical nurse but who is interested in promoting the objectives of NFLPN.
INTERNATIONAL	$70.00
INDIVIDUAL (at large)	$70.00