NPO Membership Application

Date Date is required

Application Type

New Organization Member

Renewal

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

Organization Name Organization Name is required

Organization Phone Organization Phone is required

Organization Address Line 1 Organization Address Line 1 is required

Organization Email Organization Email is required and must be in the format email@domain.com

Organization Address Line 2

Organization Website

Organization City Organization City is required

Organization State Organization State is required

Organization Zip Code Organization Zip Code is required

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

Primary Contact Name / Title Primary Contact Name / Title is required

Primary Contact Phone Primary Contact Phone is required

Primary Contact Address Line 1 Primary Contact Address Line 1 is required

Primary Contact Email Primary Contact Email is required and must be in the format email@domain.com

Primary Contact Address Line 2

Primary Contact City Primary Contact City is required

Primary Contact State Primary Contact State is required

Primary Contact Zip Code Primary Contact Zip Code is required

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.

Yes

No

Our organization supports the AANP mission.

Yes

No

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:

Total Number of Individuals in Your Organization Total Number of Individuals in Your Organization is required

Payment Method

Credit 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

Email Email must be in the format email@domain.com

Full Name

Title

Email Email must be in the format email@domain.com

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