MEMBERSHIP APPLICATION
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Direct Supervisor:

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Organization:

Address:

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Zip:

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Telephone:

Ext.:

Fax:

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Florida Registered Nurse License No.:

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Application for Membership
(please check one)

 Full (Active).............$150
Affiliate...................$150
Associate (Student)....$60
Honorary...................$60
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Executive
Faculty
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Are you a member of the American Organization of Nurse Executives (AONE)?
YES | NO
Are you a member of one of the following regional nurse leaders' professional groups? Your local chapter will receive a $25 credit towards your membership application fees.
Central Florida Organization of Nurse Executives
Northeast Florida Organization of Nurse Executives
North Central Florida Organization of Nurse Executives
Nurse Executives of Polk County
Panhandle Organization of Nurse Executives
South Florida Organization of Nurse Executives
Tampa Bay Organization of Nurse Executives
Treasure Coast Organization of Nurse Executives
Not a member of any of the above groups

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