Alberta Primary Care Nurses Association Membership Application 2019/20
Membership is open to Registered Nurses and Nurse Practitioners with an interest in primary health care.
New members can join at any time throughout the year but membership is not pro-rated.
Annual renewal date is October 31st.
Email address *
Alberta Primary Care Nurses Association www.albertaprimarycarenurses.com
Membership option *
Required
Your first name *
Your answer
Your last name *
Your answer
Your complete mailing address (please include your street/box number, town/city, province, postal code) *
Your answer
Your phone number *
Your answer
Your professional designation *
Are you interested in leadership opportunities with APCNA? *
Are you a current member of the Canadian Family Practice Nurses Association (CFPNA)? *
Your CFPNA membership number
Your answer
Years of employment in Primary Care/Family Practice: *
Do you give APCNA permission to use your contact information for the purpose of sending communication from APCNA, as well as information about relevant education, research, and or committee opportunities? *
Do you consent to have your name and contact information shared with the Canadian Family Practice Nurses Association (CFPNA) to verify/establish your membership? *
Are you willing to have your contact details displayed to other APCNA members on the APCNA Member directory? (Details will include your name, email, city) *
Do you give APCNA permission to share your contact information with your Provincial Association where applicable? *
By typing your name in the box below, you are effectively providing your signature, indicating all the information on this form is true and accurate to the best of your knowledge. *
Your answer
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