Membership Form
MEMBERSHIP INFORMATION Membership is open to RNs and LPNs with active/inactive licensure with an up-to-date Villages ID card.
(You can complete a membership form and bring it to the next meeting.)
DUES Annual membership dues are $10.00 payable at the first meeting attended in that Fiscal year. Our Fiscal year is September - May.
Guests are allowed to attend meetings, and will be charged $5.00, which will be added to the scholarship fund. Guests must be former nurses.
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You can complete a form at the meeting
OR...
you can
COPY and PASTE
the form below into a blank
Word Document
which will enable you to print this form at home.
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THE VILLAGES NURSES CLUB
MEMBERSHIP FORM
We would like to showcase our own talent and recognize our own expertise within The Villages Nurses Club. Please share with us what has made your nursing journey memorable and please let us know of other skills/interest you have that could be shared.
Please Print
Name: _________________________________________________________
Date:__________________
Credentials/Degrees: (check one)
ARNP____RN___LPN___ CRNA ___ AS degree___ BA___BSN___MSN_____
PhD Nursing____ Attorney____ Military Rank__________
Address:__________________________________________________________
City: _____________________________________ Zip ______________
Village______________________ Full time ______ Seasonal _______
Phone Number: _________________________ Cell:_________________
e-mail address:_________________________________
1) Would you be interested in serving as a committee Chairperson or a member of a Club Committee? Y _____ N _____
(If yes please circle your committee interest below)
Committees are: Membership; Nominating; Program; Refreshment; Sunshine; Raffle, Christmas Party, May Celebration
2) Area of specialty? Do you or did you leave a foot print in nursing? Did you author a text; a Professor; serve in the military or other world organizations; are you an attorney?
3) Are you willing to give a short talk (to the club) about your accomplishments?
www.thevillagesnursesclub.com
If you need more room, please write on back.. Thanks for your input.
