10 Years Membership – Georgia Indian Nurses Association

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Provides 10 years of membership.

Qualifications for the Membership:

Registered professional nurse of Indian origin or heritage.
Must have current RN license in any states or territories of USA.
Must be of good professional standing (not barred or suspended license).
Member must agree with the mission and comply with the rules and bylaws set by GINA.

MEMBERSHIP FORM

Price:

$300

First Name:* First Name Required

Last Name:* Last Name Required

Email:* Email is Required

Mobile Number:* Mobile Number is Required

Credentials:* Credentials is Required

Street address:* Street address is Required

City:* City is Required

State:* State is Required

ZIP Code:* ZIP Code is Required

Gender:* Gender is Required

Male Female Other Prefer not to answer

Highest Degree earned:* Highest Degree earned is Required

Speciality Certification: Speciality Certification is not valid

Advance Practice Provider:* Advance Practice Provider is Required

Nurse Practitioner Clinical Nurse Specialist Nurse Midwife Nurse Anesthetist Not applicable

How would you like to be involved in GINA?:* How would you like to be involved in GINA? is Required

Professional networking Continuing education activities Mentoring Career advancement self-help group Committees/Leadership Community outreach activities Not at this time

Position Description:* Position Description is Required

Nurse Clinician / Staff Nurse Nurse Informaticist Academic Educator Managers / Supervisor / Coordinator Nurse Scientist Staff Educator Patient Educator Clinical Trial Nurse Quality Improvement Director VP / CNO / CEO Consultant Entrepreneur Nurse Navigator Nurse Practitioner Retired Other

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Password Strength Password must be "Medium" or stronger

Description	Amount
10 Years Membership – Payment	$300.00
Total	$300.00

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MEMBERSHIP FORM

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