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NPO Membership Application

Date

Application TypeNew Organization MemberRenewal

ORGANIZATION INFORMATION
The organization information will be available to members-only in the AANP online NP Organization Member Directory.

Organization Name

Organization Phone

Organization Address Line 1

Organization Email

Organization Address Line 2

Organization Website

Organization City

Organization Zip Code

PRIMARY CONTACT INFORMATION
Periodicals and other membership correspondence will be addressed to the person and address listed below.

Primary Contact Name / Title

Primary Contact Phone

Primary Contact Address Line 1

Primary Contact Email

Primary Contact Address Line 2

Primary Contact City

Primary Contact Zip Code

ELIGIBILITY REQUIREMENTS
To be eligible to apply, your organization must consist of five or more NPs and support the AANP mission.

Our organization has five or more NPs.YesNo

Our organization supports the AANP mission.YesNo

We are organized as one of the following (please check one):NP professional membership association.University or college offering an NP program.Government or military group or organization.Clinic or hospital.

ORGANIZATION ANNUAL DUES
Select the size of your organization for the appropriate annual dues:

Payment MethodCredit Card (All major cards accepted) – Upon approval, a secured link will be emailed to the primary contact for online payment.Check – Upon approval, an invoice will be emailed to the primary contact. Please print and return with payment.

Additional Contacts (Optional)

Additional NPO contacts will have access to the NPO resource page.

Full Name

Title

Full Name

Title

NP Organization membership is subject to approval. Benefits and pricing are subject to change without prior notice. Dues are nonrefundable.

AANP dues are not tax deductible as a charitable contribution, but may be deductible as a business expense. AANP estimates that 15% of your dues are not deductible because of AANP lobbying activities.