JOIN ANA & VNA NOW! - Virginia Nurses Association

Celebrating
National
Nurses
Week
May 6–12, 2014
JOIN ANA & VNA NOW!
May 6-12, 2014, is a special time when
nurses from every practice specialty join
together to celebrate National Nurses
Week. This year's theme highlights the
nursing profession's critical leadership
role as health care continues to evolve.
Celebrate National Nurses Week 2014 by joining
ANA and the Virginia Nurses Association
ANA and the Virginia Nurses Association are
empowering nurses with resources, programs and
standards that help you advance your career
and your profession.
Benefits include:
• Free and discounted continuing education modules
• Exclusive discounts on certification through the
American Nurses Credentialing Center (ANCC)
• Free subscriptions to ANA journals and newsletters
• Support for ANA and VNA's advocacy efforts,
which help protect your practice and improve
the quality of care
10% off of your firstyear membership dues
if you join ANA and the
Virginia Nurses
Association by June 30.
To receive this offer, complete
the membership application
on the reverse side or go to
www.joinana.org and use
code NNW14.
Now is the perfect time for you to join ANA
and the Virginia Nurses Association
www.joinana.org
ANA Membership Application
For dues rates and other information, contact ANA’s Membership Billing Department at (800) 923-7709 or e-mail us at memberinfo@ana.org
Essential Information
First Name/MI/Last Name
Date of Birth
Mailing Address Line 1
Credentials
Mailing Address Line 2
Phone Number
City/State/Zip
Email address
Gender: Male/Female
Circle preference: Home/Work
How did you hear about ANA?
County
Magazine
Online
Colleague
Mail
Other: __________________________
Professional Information
Employer
Current Employment Status: (ie: full-time nurse)
Type of Work Setting: (ie: hospital)
Current Position Title: (ie: staff nurse)
Practice Area: (ie: pediatrics)
RN License #
Ways to Join
Ways to Pay
Annual Payment
✓ ANA and State Membership
10% discount valid only for membership in ANA and state organizations. Excludes ANA only,
eMembership, and state only membership options. Not valid for retired or new graduate categories.
After the first year, membership will renew at the current rate in effect at that time. This offer is good for
both annual and monthly payment options.
Membership Dues Dues vary by state. Visit joinana.org to check
dues rate in your state.
Dues Rate ...............................................................................$
Check
Credit Card
State
If paying by credit card, would you
Yes
like us to auto bill you annually?
Monthly Payment
Checking Account Attach check for first month’s payment.
Credit Card
Authorization Signatures
ANA-PAC Contribution (optional)...................................$
ANF Contribution (optional) ............................................$
Monthly Electronic Deduction | Payment Authorization Signature*
Total Dues and Contributions ..........................................$
Credit Card Information
Credit Card Number
Visa
Mastercard
Expiration Date (MM/YY)
Authorization Signature
Automatic Annual Credit Card | Payment Authorization Signature*
*By signing the Monthly Electronic Payment Deduction Authorization, or the Automatic Annual
Credit Card Payment Authorization, you are authorizing ANA to change the amount by giving the
above signed thirty (30) days advance written notice. Above signed may cancel this authorization
upon receipt by ANA of written notification of termination twenty (20) days prior to deduction date
designated above. Membership will continue unless this notification is received. ANA will charge a $5
fee for any returned drafts or chargebacks. Full and Direct members must have been a member for six
consecutive months or pay the full annual dues to be eligible for the ANCC certification discounts.
Go to joinana.org to become
a member and use the code:
Printed Name
NNW14
Please Note — $20 of your membership dues is for a subscription to The American Nurse and $27
is for a subscription to American Nurse Today. American Nurses Association (ANA) membership dues
are not deductible as charitable contributions for tax purposes, but may be deductible as a business
expense. However, the percentage of dues used for lobbying by the ANA is not deductible as a
business expense and changes each year. Please check with ANA for the correct amount.
Fax
Web
Mail
Completed application with credit card
payment to (301) 628-5355
Join instantly online.
Visit us at www.joinana.org
ANA Customer & Member Billing
PO Box 504345
St. Louis, MO 63150-4345