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		Renew or Join The National Association of Hispanic Nurses We ask that you please review the membership categories before applying. If you are not in a program leading towards licensure as an RN or LPN/LVN, you may not join as a student member. Therefore, if you already have an RN license, please join as a full member. It can take up to two to three weeks to receive your membership id card (which will contain your membership id number). Membership id cards are sent out via the mail. You will not receive your id number via e-mail. Join Online, or Print Application (pdf)
		Member Name
First Name
Middle Name
Last Name
Credentials		(eg. RN, LVN, MSN, PhD, ...)
		License Information (required for full membership)
License #		Include license type (RN, LVN, LPN, ...)
License State
License Expiration Date
Membership Id		(if current or former member)
Record Update Only (y/n)
Membership Category		Select Full National - $75 (no Chapter) Full National - $100 (with Chapter) Full National - $175 - Two Year (with Chapter) Associate - $50 Associate - $75 (with Chapter) Affiliate - $50 Affiliate - $75 (with Chapter) International - $50 International - $75 (with Chapter) Retired - $50 Retired - $65 (with Chapter) Student - $30 Student - $40 (with Chapter) Full For Hispanic/Latino/Latina nurses licensed in the US and its jurisdictions • Full National - $75 (no Chapter) • Full National - $100 (with Chapter) • Full National - $175 - Two Year (with Chapter) Associate Non-Hispanic/Latino/Latina US-licensed nurses interested in solving problems/needs of Hispanic/Latino/Latina community • Associate - $50 • Associate - $75 (with Chapter) Affiliate For non-nursing health care professionals interested in solving problems/needs of Hispanic/Latino/Latina nurses • Affiliate - $50 • Affiliate - $75 (with Chapter) International Licensed Hispanic/Latino/Latina nurses not residing in the US or its jurisdictions • International - $50 • International - $75 (with Chapter) Retired Hispanic/Latino/Latina US-licensed nurses 62 years or older who are not employed full-time in nursing • Retired - $50 • Retired - $65 (with Chapter) Student Student currently enrolled in a RN, LPN/LVN nursing program leading to licensure. • Student - $30 • Student - $40 (with Chapter) Voting Membership Full and Retired are the only categories with voting privileges.
		Chapter Selection (Required if selecting a Chapter membership level.)
Local Chapter		Select if applicable Arizona - Angeles del Desierto (Yuma) Arizona - Valle del Sol (Phoenix) Arizona - San Xavier (Tucson) Arkansas - Arkansas California - Los Angeles Chapter California - Inland Empire (San Bernardino) California - Orange County California - San Diego California - San Francisco Bay Area California - Greater San Jose Area California - Imperial Valley California - San Joaquin Valley Chapter Colorado - Colorado Chapter Colorado - Southern Colorado Chapter Delaware - Delaware Florida - Miami Florida - Greater Orlando Florida - Broward County Georgia - Atlanta Georgia - Savannah Illinois - Illinois Kentucky - Kentucky Massachusetts - Massachusetts Michigan - Michigan Nebraska - Nebraska Nevada - Las Vegas New Jersey - New Jersey New York - New York North Carolina - North Carolina Oregon - Oregon Pennsylvania - Philadelphia Puerto Rico - Puerto Rico Rhode Island - Rhode Island Texas - Brownsville Texas - Corpus Christi Texas - Dallas Texas - El Paso Texas - Houston Texas - Lubbock Texas - San Antonio Washington - Eastern Washington Washington DC - Washington DC Wisconsin - Wisconsin
Additional Chapter		Select if applicable Arizona - Angeles del Desierto (Yuma) Arizona - Valle del Sol (Phoenix) Arizona - San Xavier (Tucson) Arkansas - Arkansas California - Los Angeles Chapter California - Inland Empire (San Bernardino) California - Orange County California - San Diego California - San Francisco Bay Area California - Greater San Jose Area California - Imperial Valley California - San Joaquin Valley Chapter Colorado - Colorado Chapter Colorado - Southern Colorado Chapter Delaware - Delaware Florida - Miami Florida - Greater Orlando Florida - Broward County Georgia - Atlanta Georgia - Savannah Illinois - Illinois Kentucky - Kentucky Massachusetts - Massachusetts Michigan - Michigan Nebraska - Nebraska Nevada - Las Vegas New Jersey - New Jersey New York - New York North Carolina - North Carolina Oregon - Oregon Pennsylvania - Philadelphia Puerto Rico - Puerto Rico Rhode Island - Rhode Island Texas - Brownsville Texas - Corpus Christi Texas - Dallas Texas - El Paso Texas - Houston Texas - Lubbock Texas - San Antonio Washington - Eastern Washington Washington DC - Washington DC Wisconsin - Wisconsin (adds $25)
		Member Ambassador
Referred By
Member Id
Certify Eligibility:		(Yes or No) I certify that I am eligible for membership in the category I have selected. If I have applied for full or retired Hispanic Nurses Association membership, I am of Hispanic or Latino/Latina origin, and I have a U.S. license to practice nursing in the United States.
		Student Information (required for students)
Student School
School Program Name
Graduation Date
		Home/Mailing Address (required)
Address
City
State
Zip
Country
Phone
Fax
Email
		Current Employment (optional)
Employer
Position or Title
Address
City
State
Zip
Country
Phone
Fax
Email
		Education Level (please provide some details)
Doctorate Nursing
Doctorate (Not in Nursing)
Masters Nursing
Masters (Not in Nursing)
Baccalaureate
Associates Degree
H.S. Diploma
Voc-Tech
		Racial/Ethnic Background Full membership or Retired membership must indicate Hispanic, Latina, Latino Heritage
Hispanic/Latino/Latina		(y/n)
African American		(y/n)
White		(y/n)
Asian American		(y/n)
Native American		(y/n)
Other		(y/n)
Payment Name		Name of person paying for membership (so we can match payment to member).
Payment Type		eg. Paypal, Credit Card using Paypal, Mail a Check, No Payment - Update Only