2017 OHE Membership Application (New Members & Renewals)
Please choose one or more responses below
In order to expedite your membership application, please specify
New Member (I have never been a member)
Renewal Member (I am a current member, renewing)
Past Member (I was a member in the past, have lapsed, am renewing)
Updating my address/information on file (information on file is outdated)
Print your Name (Last, First)
Preferred Mailing Address- Street, Number (and apt# if applicable)
Preferred Mailing Address City & Zip
Preferred Contact Telephone #
Highest Nursing Degree(s)
I am a Nursing Student
Area(s) of Specialty
Please include my name and e-mail in the OHE Website/ Directory
Please include my specialty information in a members-only resource listing
Are you an ANPD Member?
This fee is for membership during current calendar year and is non-transferable. * Organization/ Facility membership fee is for each member when initially registering three (3) members from same organization or facility at the same time. A completed membership application must be submitted for each member.
Active (Individual) $45.00/ year
Student $15.00/year (Must include Degree & date of anticipated graduation in comments)
Organization/ Facility $40.00/ per person per year*
If you chose the student option, include degree and graduation date here:
Please indicate method of payment for Membership
PayPal (link will be provided after form is submitted)
Mail-in personal check
Organization/Facility Corporate check
Combined with program payment
We invite you to share your expertise by joining one of our Board Members in their activities
Please indicate your interest and a Board Member will contact you
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