RNS Membership Application

(Printable version)

In an effort to increase our membership and to maintain the viability of RNS, we are resuming our membership drive.  Therefore, if you are a member of RNS, recruit five (5) new members to RNS in a one year time frame (between January 1, 2009 and December 31, 2009), and you have the option of a free one year membership to RNS or a free registration to the RNS Educational Conference. 
New members recruited must indicate at the time of initial application for membership the sponsoring RNS member to be considered a valid recruitment.

(PLEASE PRINT)                                                         

If change in address/or membership information, please check: ________

Date_________________________________

Name________________________________

Credentials____________________________

Home Address__________________________________________________

City_________________________ State_______ Zip_________

Home Phone_____________________

Work Phone______________________

Fax________________________

Email address_____________________________________________

Place of employment/address_______________________________________

Position/Title_________________________________

Sponsoring RNS Member_______________________________________

Membership fees:

___ Voting membership $75

___ Associate membership $75

___ Student membership $50

___ Retired membership $50

___ Corporate membership $1,500

Do you want your name and address on a list that may be made available for purchase by other professional health care organizations? ____Yes  _____No

Payments may be made via check or credit card. Checks should be made payable to Respiratory Nursing Society.  If paying by credit card, please clearly print the following:

Credit card #_________________________

Name on Credit Card (Print clearly)_________________________________

Expiration date __________________

Amount______________

Signature__________________________________

Please mail application and payment to:

Respiratory Nursing Society

c/o Donna Bond

309 E. Lee Avenue

Vinton, VA  24179