NEW JERSEY STATE SCHOOL NURSES ASSOCIATION 
Membership Application

Advantages of Membership  |  Who May Join?  |   Affiliations

Our membership continues at the same low rate

(Print or Type)

  Dues Structure  

Home Address:  _______________________________________________
                                                                   Street  

_____________________________________________________________ 

  City                                    State                       Zip                                                

Phone:   Home (      ) ________________  Work  (      ) _________________      

E-mail:  _______________________________  Fax:  (      ) _______________ 

Employer:________________________________________________________  

County:    (Home)  __________________ (Work) _________________________

DUES FOR 2007/2008
 ______  Regular  $48.00

 ______  Associate  $36.00

 ______  Student  $24.00

 ______  Retired  $24.00

______  Member-at-Large $36.00

Definition of membership type

ABSOLUTELY NO  PURCHASE ORDERS 

Make check payable to:  NJSSNA and mail to:
Muareen Leavy
Membership Chairperson
PO Box 127
Great Meadows, NJ 07838

 Membership Year:  06/01/07 - 5/31/08 (Please check one)

_____ New Address       _____New Name     ____New Member

______Renewal    ______Change of Membership