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South Carolina Faith Community Nurses Membership Application and Contact Information
Annual membership January 1 to December 31
* Indicates required question
Date
*
MM
/
DD
/
YYYY
Application Status
*
New member 2026
Renewing member 2026
Name(include credentials
*
Your answer
Email
*
Your answer
Address
*
Your answer
Reliable phone number where you can been reached. Indicate if you can receive texts at the number given.
Your answer
Church Affiliation
Your answer
Church Address
Your answer
Completed Faith Community Nursing Course or Foundations Course
yes
No
Clear selection
If yes to above question, what was the date and location of your course?
Your answer
Current employment status as a Faith Community Nurse
Full-time
Part time
Unpaid
Clear selection
Hours worked per week as faith community nurse
Your answer
What is your title?
Your answer
How long have you practiced in this role?
Your answer
If employed by more than one faith organization, please list all those your serve.
Your answer
Please use the PayPal option on the website scfcna.com under membership to pay annual dues.
Your answer
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