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Become a Member of NFLPN

To join online use the form below

For print version to mail

Membership Application

United States Address				Address:
First Name:				Last Name:		PN License #/State:
Cell Phone:				Wk Phone Number:		Home Phone Number:
City:				State:		ZIP:
International Address				Address:		City:
Province:				Country:		Postal Code:
Credentials:						Email Address:
Date of Birth:	month	day	year		Referred By:
					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 (At Large) membership. Individual, Military and International Members must select "At Large" from the State Affiliation list.

Membership Type
(choose one from the following types)

	Active		Retired		Military		Student
			Affiliate		International		Individual

Once payment is processed, you will receive an email to confirm membership processing and a separate email to confirm your payment transaction. If you elect to receive your NFLPN correspondence electronically, you will receive your membership card and full benefit information via email within the next 20 business days. If you elected not to receive your correspondence electronically, please allow up to 30 business days to receive your membership card and information in the mail. You may use your membership confirmation email as proof of membership in the meantime.

Refund Policy: There are NO refunds for membership. Please make sure you are ready to become a member before processing your application. If you are unsure which membership category to apply for, email nflpn@mgmt4u.com for assistance. If you experience an error in membership payment processing, please notify NFLPN in writing or via email at nflpn@mgmt4u.com within 72 hours of error.

Or Submit form and pay online now