Step 6: Payment

Please provide the following information so that we may complete your membership application.

Applicant's Certification

By clicking the "Submit" button below, I certify that I am eligible for and am applying for NSNA membership. I AM CURRENTLY ENROLLED IN NURSING SCHOOL or a PRE-NURSING PROGRAM. I authorize the NSNA to request documentation from the registrar and nursing program to verify my enrollment status. I certify that all statements made in this application are complete and accurate. I understand that:

- falsification in my application will disqualify my application.
- failure to follow all instructions on this application will render my application incomplete.
- INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

Membership is non-transferrable.
Membership dues are non-refundable.



Before submitting your credit card payment, please ensure that the billing address information listed below is the one that appears on your credit card statement, the amount due shown is what you expect, and that you have entered a valid credit card type, number, expiration date, and the name that appears on the card. This information is kept in strict confidence, but may be provided to the banking networks to aid them in the event of a fraud investigation. All transactions on this site are secured and encrypted using SSL technology.

Select your Membership*:  

**Please enter the address as shown on the credit card
Name*:
 
 
Card Number*:
 
Expiration Date*:  

 (MM/YY)
Card*:
 
 
Card Verification Code*:
 

Click here to see how to locate your verification code.
Foundation of the NSNA (FNSNA) Contribution amount:
   The FNSNA is organized for charitable and educational purposes, the Foundation awards scholarships to qualified nursing students. Contributions to the FNSNA are tax-deductible.
Address 1*:
 
Address 2:
City*:
 
State*:
 
Zip Code*:
 
Country*:
Preferred Phone#*:
 

 

When clicking the Authorize button, only click it once. It can take up to 2 Minutes for your transaction to be processed and the transaction confirmation to appear on your screen.