NJAPHNA: 2018 MEMBERSHIP APPLICATION
New Jersey Association of Public Health Nurse Administrators, INC.
1. Fill out this application form and click submit, you will receive a confirmation email afterwards
2. Print out your confirmation email and send it along with a check or PO payable to NJAPHNA
Send in your payment to
31 Ivanhoe Lane, Clifton NJ 07013
Home Address (including city, state and Zip)
Employer (please indicate if you are retired)
Work Address (including city, state and Zip)
Type of Membership
Active membership ($75 due)
Associate (retired) membership ($35)
Check if you are willing to serve the following committees (you can pick more than one)
All Hazards/ Emergency Preparedness
A copy of your responses will be emailed to the address you provided.
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