MEMBERSHIP INFORMATION & offline application (fill out and submit this form both if you have paid via credit card or plan to join offline)
(Only ACTIVE member category has a vote.)
Fill out the following, hit the SUBMIT button, and if you haven't paid via credit card, send your check or money order to:
Your name:
Street address:
City:
State:
Zip code:
Home phone:
Work phone:
FAX:
Nursing license #:
States licensed in:
LMT/CMT license #:
e-mail address:
Nursing specialties:
Massage/bodywork specialties:
Check all that apply to you: this is a renewal this is a new membership application
RN LPN/LVN LMT CMT
Type of membership you are applying for:
ACTIVE STUDENT INDIVIDUAL SUPPORTING CORPORATE SUPPORTING SENIOR
CHECK ONE:
Upon payment of my membership dues, I do do not want my information included in the NANMT membership directory.
(I testify that all information supplied on this application form is true and correct. I understand that I am responsible for notifying NANMT within 30 days should any changes in information occur.)
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1-800-262-4017