2023 SNO Registration Form

Participant Info

First Name *

Last Name *

Name as you would like it to appear on your badge: *

Home Address *

Address

City *

State *

Zip Code *

Email *

Please be sure to include a current, active email address, as all correspondence regarding the program will be sent via email.

Phone

Cell/Home Phone *

Work Phone *

School Info

School District *

For independent school, enter school name.

County *

Position and Level

Participant Qualifications (copy)

NYS RN License # *

PLEASE NOTE: Participation in School Nurse Orientation is limited to registered professional nurses, nurse supervisor or nurse practitioner.

Start Date as School Nurse: *

Previous experience as a School Nurse

3 or more years
2 years
1 year
This is my first year

Preference is given to school nurses with less than three years’ experience. If space is available, school nurses with more experience will be accepted. Please indicate if you would like to be added to the waiting list. You will be contacted if space becomes available.

Please list any special dietary needs: *

Registration Type:

Registraton Type

On or before 7/20/23:

NYSASN Member - $500.00
Non-Member - $550.00

AFTER 7/20/23:

NYSASN Member - $525.00
Non-Member - $575.00

NYSASN Member - $500.00

NYSASN Member - $525.00

Non-Member - $550.00

Non-Member - $575.00

Payment Method *

PayPal/Credit Card
Check or Money Order
Purchase Order (Please provide accounts payable contact information below.)

Check/money order payment is due in full no later than August 7, 2023. Mail your payment to: O. Jeanne Dolly, Registrar 81 Rowley Street Gouverneur, NY 13642

Name of primary billing contact *

First

Last

For check/money order or purchase order payment, you will be redirected to the confirmation screen after clicking "Submit." For credit card/PayPal, you will be taken to the PayPal screen to complete your transaction. Click "Return to Merchant" to be redirected to the confirmation screen. In addition to the onscreen confirmation message, you will also receive a confirmation email, once your registration is submitted, and in the case of PayPal, once your payment has been processed. Please contact the registrar directly if you have not received the confirmation email.

Total

$ 0.00

2023 School Nurse Orientation (SNO) Registration

Registration Type:

Thank you