Application for ANA-New York Organizational Affiliates
To apply for membership, please complete all questions.
Organization Name
Primary Contact
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Phone Number
-
Area Code
Phone Number
Primary Organization Phone Number
-
Area Code
Phone Number
E-mail
*
Website/Facebook
Upload a copy of your Organization's Mission and Purpose
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Number of Members (Note: Annual renewal of $100 is due January)
$100: 1-100 RN members
$125: 101-200 RN members
$150: 201-300 RN members
Plus $10 for each additional 100 members
Other
Year Incorporated
Annual or Biennial Meeting? When?
Number on Executive Board
Number of RNs on Executive Board
Upload a copy of your bylaws and a current list of board members
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