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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 even if you are currently a student in other programs, please join as a General 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)
Is this a renewal? (y/n)
Membership Category		Select General National (formerly Full and Associate) - $100 (no Chapter) General National (formerly Full and Associate) - $125 (with Chapter) General National (formerly Full and Associate) - $225 - Two Years (with Chapter) General National - $175 (formerly Full and Associate) - Two Years (no Chapter) Affiliate - $75 (no Chapter) Affiliate - $100 (with Chapter) International Associate - $75 (no Chapter) International Associate - $100 (with Chapter) Emeritus (formerly Retired) - $75 (no Chapter) Emeritus (formerly Retired) - $90 (with Chapter) Student - $30 (no Chapter) Student - $40 (with Chapter) General (previously Full and Associate):* For any nurse licensed in the United States and its jurisdictions and who is interested in helping to solve the healthcare problems and support the healthcare needs of the Hispanic/Latino(a) community • General (previously Full and Associate) National - $100 (no Chapter) • General (previously Full and Associate) National - $125 (with Chapter) • General (previously Full and Associate) National - $175 - Two Year (no Chapter) • General (previously Full and Associate) National - $225 - Two Year (with Chapter) Affiliate For non-nursing health care professionals interested in solving problems/needs of Hispanic/Latino(a) nurses • Affiliate - $75 (no Chapter) • Affiliate - $100 (with Chapter) International Associate Licensed Hispanic/Latino(a) nurses not residing in the US or its jurisdictions • International - $75 (no Chapter) • International - $100 (with Chapter) Emeritus (formerly Retired) Hispanic/Latino(a) US-licensed nurses 62 years or older who are not employed full-time in nursing • Retired - $75 (no Chapter) • Retired - $90 (with Chapter) Student Student currently enrolled in a RN, LPN/LVN nursing program leading to licensure. • Student - $30 (no Chapter) • Student - $40 (with Chapter) Voting Membership General and Emeritus 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 - San Xavier (Tucson) Arizona - Valle del Sol (Phoenix) Arkansas - Arkansas California - Greater San Jose Area California - Imperial Valley California - Inland Empire (Riverside) California - Los Angeles Chapter California - Orange County California - San Diego California - San Francisco Bay Area California - San Joaquin Valley Chapter Colorado - Colorado Chapter (Denver) Colorado - Southern Colorado Chapter Connecticut - Connecticut Connecticut - Hartford Delaware - Delaware Florida - Broward County Florida - Greater Orlando Florida - Miami Georgia - Atlanta Georgia - Savannah Illinois - Illinois Kansas - Girasol (Wichita) Kentucky - Kentucky Massachusetts - Massachusetts Massachusetts - Southeastern Massachusetts Michigan - Michigan Missouri - El Corazon de la Tierra Nebraska - Nebraska Nevada - Las Vegas New Jersey - New Jersey New York - Long Island New York - New York North Carolina - North Carolina Oregon - Portland 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 Texas - Valle (McAllen) Virginia - Richmond Washington - Eastern Washington Washington - Southeastern Washington Washington DC - Washington DC Wisconsin - Wisconsin
Additional Chapter		Select if applicable Arizona - Angeles del Desierto (Yuma) Arizona - San Xavier (Tucson) Arizona - Valle del Sol (Phoenix) Arkansas - Arkansas California - Greater San Jose Area California - Imperial Valley California - Inland Empire (Riverside) California - Los Angeles Chapter California - Orange County California - San Diego California - San Francisco Bay Area California - San Joaquin Valley Chapter Colorado - Colorado Chapter (Denver) Colorado - Southern Colorado Chapter Connecticut - Connecticut Connecticut - Hartford Delaware - Delaware Florida - Broward County Florida - Greater Orlando Florida - Miami Georgia - Atlanta Georgia - Savannah Illinois - Illinois Kansas - Girasol (Wichita) Kentucky - Kentucky Massachusetts - Massachusetts Massachusetts - Southeastern Massachusetts Michigan - Michigan Missouri - El Corazon de la Tierra Nebraska - Nebraska Nevada - Las Vegas New Jersey - New Jersey New York - Long Island New York - New York North Carolina - North Carolina Oregon - Portland 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 Texas - Valle (McAllen) Virginia - Richmond Washington - Eastern Washington Washington - Southeastern 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 General or Emeritus Hispanic Nurses Association membership, 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
Hispanic/Latino/Latina		(y/n)
African American		(y/n)
White		(y/n)
Asian American		(y/n)
Native American		(y/n)
Other		(Yes/No)
Payment Name		Name of person paying for membership (so we can match payment to member).
Payment Type		Please specify - eg. Paypal, Credit Card using Paypal, Mail a Check