Membership application
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February 2003 29:1 JOURNAL OF EMERGENCY NURSING 15A EMERGENCY NURSES ASSOCIATION 915 Lee Street, Des Plaines, IL 60016 www.ena.org Name Title Chapter # Social Security # Address (home or work) City State Zip/PC Country Home Phone Work Phone Fax Number E-mail Do not include me on ENA’s mailing list when it is provided to other organizations. PROVIDE PAYMENT INFORMATION Check enclosed payable to ENA (US dollars only) Visa MasterCard Discover AMEX Account Expires Signature Date Tax deductible gift to ENA Foundation Member-Get-a-Member Recruiter (Optional) Recruiter ID # CHOOSE ONE MEMBERSHIP CATEGORY: Membership type Term Cost AZ, FL or MA* CA* " Active Member " 1 yr $96 $101 $121 " 3 yr $240 $255 $315 " 5 yr $360 $385 $485 " Lifetime $1200 $1265 $1525 " NSNA Member (NSNA # ___________) " 1 yr $36 N/A N/A " Affiliate (LPN, LVN) or Retired Member " 1 yr $57 $62 $82 " International Member " 1 yr $86 N/A N/A " Military Member (APO, FPO address) " 1 yr $86 N/A N/A # RN Nursing Student " 1 yr $48 N/A N/A Residents of Arizona, Florida, Massachusetts, and California are subject to the membership fees listed above to cover the state council assessment fee. (These fees do not apply to NSNA, International, or Military categories.) ENA membership is valid for 1 year. The month in which you join is considered your renewal month. We will mail you a new member packet with information about the Association and a membership card. $8.50 of ENA dues is a subscription to the Journal of Emergency Nursing. $6.50 of ENA dues is a sub- scription to ENA Connection. Your dues payment is not deductible as a charitable expense, but might be deductible as a business expense. Please consult your tax advisor. ENA estimates that 5% of the dues pay- ment is not deductible as a business expense because of ENA’s lobbying activities on behalf of members. Send application to: ENA Membership Department 915 Lee St Des Plaines, IL 60016 Questions: Call (800)243-8362. MEMBERSHIP APPLICATION—JOIN ENA!
Transcript of Membership application
February 2003 29:1 JOURNAL OF EMERGENCY NURSING 15A
E M E R G E N C Y N U R S E S A S S O C I A T I O N
915 Lee Street, Des Plaines, IL 60016
www.ena.org
Name Title
Chapter # Social Security #
Address (home or work)
City State
Zip/PC Country
Home Phone Work Phone
Fax Number E-mail
Do not include me on ENA’s mailing list when it is provided to other organizations.
PROVIDE PAYMENT INFORMATION
Check enclosed payable to ENA (US dollars only)
Visa MasterCard Discover AMEX
Account Expires
Signature Date
Tax deductible gift to ENA Foundation
Member-Get-a-Member Recruiter (Optional) Recruiter ID #
CHOOSE ONE MEMBERSHIP CATEGORY:
Membership type Term Cost AZ, FL or MA* CA*
" Active Member " 1 yr $96 $101 $121" 3 yr $240 $255 $315" 5 yr $360 $385 $485" Lifetime $1200 $1265 $1525
" NSNA Member (NSNA # ___________) " 1 yr $36 N/A N/A
" Affiliate (LPN, LVN) or Retired Member " 1 yr $57 $62 $82
" International Member " 1 yr $86 N/A N/A
" Military Member (APO, FPO address) " 1 yr $86 N/A N/A
# RN Nursing Student " 1 yr $48 N/A N/A
Residents of Arizona, Florida, Massachusetts, and California are subject to the membership fees listedabove to cover the state council assessment fee. (These fees do not apply to NSNA, International, orMilitary categories.)
ENA membership is valid for 1 year. The month in which you join is considered your renewal month.We will mail you a new member packet with information about the Association and a membership card.$8.50 of ENA dues is a subscription to the Journal of Emergency Nursing. $6.50 of ENA dues is a sub-scription to ENA Connection. Your dues payment is not deductible as a charitable expense, but might bedeductible as a business expense. Please consult your tax advisor. ENA estimates that 5% of the dues pay-ment is not deductible as a business expense because of ENA’s lobbying activities on behalf of members.
Send application to:ENAMembership Department915 Lee StDes Plaines, IL 60016
Questions: Call (800)243-8362.
M E M B E R S H I P A P P L I C A T I O N — J O I N E N A !
