Please accept this application for membership: Choose One New Member Renewal in the Gerontological Nursing Association Ontario Chapter: Choose One Bluewater (Grey & Bruce Counties) Durham Region Hamilton Kingston Lambton London Niagara Nipissing (N. Bay/ Sudbury and area) Northwest (Thunder Bay & area) Ottawa Toronto
College of Nurses # I am a member of: Choose One RNAO* RPNAO* CGNA
Name
Mailing Address
City Prov. P.C.
Tel. (Res.) Tel. (Work)
Email Fax:
**Membership in the GNAO automatically includes membership with the CGNA. You will be contacted directly by CGNA for your login and password to access the "members only" section of the CGNA website.
Membership Category: Choose One Regular $65.00 Associate $30.00 Student Associate**$30.00 Retired $30.00 Professional Class: Choose One RN RPN PSW or HCA Other
Position: Choose One Staff Front Line Manager Senior Manager CNS/NP Educator Consultant Other Type of Facility: (primary function only) Choose One Acute Care Hospital Complex Continuing Care Mental Health Care Long Term Care Public Health Unit Retirement Home Community Care Education Facility Other
Payment is required before membership is activated. Please submit cheque within 14 days to: Gerontological Nursing Association, P.O. Box 368, Postal Station "K", Toronto, ON M4P 2G7
* Membership can be connected through the RNAO or RPNAO ** Payment of the GNAO membership fee is waived for students who are also student associate members with the RNAO or RPNAO (membership information must still be completed in full and submitted either directly to the GNAO or through RNAO/RPNAO).
Agency/Employer:
Do you have a question or concern? Please use the area below or email us at admin.gna@gmail.com
Date:
Thank you! We look forward to having you as a member. Please PRINT a copy of this form for your records before submitting.
