Become a Member of NYSASN by completing and submitting the online form below. We use PayPal to process your online payment.

If you prefer, you can also download and print the membership form and mail it with your payment.

Membership Dues
Classes of Membership defined

$55.00 Active Member
$55.00 Associate Member
$30.00 Retired Member
$30.00 Student Member
$100.00 Organization/Business Member

 


 

Type of membership:
NewRenewal

Your Information:

First Name (required)

Last Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Home or Cell Phone (required)

Home or Cell Phone (alternate)

Preferred Email (required)

Your School Information:

District

School

School Address

School City

School State

School Zip

School County

School Phone

School Fax

Education - Check all that apply
DiplomaAASADBSBABSNMastersDoctorate

Area of Practice - Check all that apply
Pre-KElementaryMiddle SchoolHigh SchoolSpecial EducationPublicPrivateCharterParochialOther

Credentials - Check all that apply
SNSNTNPFNPPNPSNPSupervisorSubCSNTNCSN

RN License # (if applicable)

Affiliations - Check all that apply
NASNNYSNAANANYSUTCSEA

Interests - Check all that apply
Board of DirectorsConference PlanningZone Activities

Terms and Conditions:
NYSASN makes its lists of member names and addresses available to carefully screened companies and organizations whose products and offerings may be of interest to you. Membership list rentals are an important and valuable source of income for NYSASN and provide members with information about products and services. If you prefer NOT to receive information concerning products and services, please check this box: Opt Out

Total Dues

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