Application

*Full members are registered nurses holding a formal or informal leadership role in their health care organization, faculty in nursing programs, including deans and directors; consultants in nursing administration/management practice; editors of professional nursing journals; and retired NHONL members.

Retired members: [Dues: $50]

Associate members (RNs who are furthering their education to assume a leadership role):

Institutional associate member* [Dues: $300]

*Institutional associate membership. This allows the institution to send any two staff members to attend each meeting on a rotational basis. To accomplish this, the institution must have at least one full member current.

FIRST NAME:	MI:	LAST NAME:
TITLE:
INSTITUTION:
ADDRESS1:
ADDRESS 2:
TOWN:		STATE:	ZIP CODE:
MAIN PHONE:		DIRECT LINE:
E-MAIL:
HOME ADDRESSS (not posted on Internet)		HOME PHONE:
ADDRESS1:
ADDRESS 2:
TOWN:		STATE:	ZIP CODE:
Are you a member of the Association of Nurse Executives (AONE)?			YES NO
If not, do you plan to join?		YES NO

After completing your application on-line, please print for your own records and submit. Remember to send your check for the appropriate amount of dues owed to Dolores Hopper, RN, MBA, FACHE, Dolores (Dee) Hopper, RN, MBA, FACHE Director of Inpatient Services Wentworth-Douglass Hospital 789 Central Avenue Dover, NH 03820.

I would like to participate in the following committee(s):

Education

Communication/Membership

Legislative