NNPBC Membership Form - 2021

Please fill the membership form below.

Contact Information
Name*
First name (official) Preferred name (if different from official) Last name
Home Address*
Street Address Address Line 2 City Province / State Postal Code Country
Hidden
Email address
Home Phone*
Mobile Phone
Designation*
Current nursing designation or past designation if retired.
Nursing Registration Number*
Primary Employer
Years of Practice*
Please enter a number from 0 to 100.
Nursing sub-specialty
Do you identify yourself as an Aboriginal person, that is First Nations, Inuit or Métis?
- Yes
- No
- Prefer not to answer
If you identify as an Aboriginal person are you:
- First Nations
- Inuit
- Métis
School Information
School
Program
Graduation Year
Student ID #
Professor/Teacher Reference Name
Communication Preferences
Allow Councillor
- I give NNPBC consent to share my contact details with my local NNPBC Councillor for communications purposes.
Hidden
Untitled
- Web Update

NNPBC Office: #500 - 3777 Kingsway, Burnaby, BC V5H 3Z7 | Toll Free: (877) 635-2639 | Email: info@nnpbc.com | Privacy Policy | Terms of Use

We recognize that your SPAM filters may inadvertently mark email from us as 'junk'. Please make sure to check your junk folder and add NNPBC as a safe sender.

Membership form 2021

Contact Information

School Information

Communication Preferences

Login to NNPBC