SVN membership application

SOCIETY FOR VASCULAR NURSING SVN MEMBERSHIP APPLICATION For membership in the Society for Vascular Nursing, please complete the following application. Dues are $75 (US and Canadian members) or $90 (international members). U.S. funds are payable through a U.S. bank only. Dues are taxdeductible (as determined by law). Thirty-five dollars ($35) of the dues payment is applied toward a one year subscription to t h e J o u r n a l o f Vascular N u r s i n g , the official publication of SVN, published quarterly.

Please type or print clearly and list name and credentials as you would like them to appea r on membership certificate.

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Name

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Home Address

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City___

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Home Telephone (

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Employer__

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Business Address

Credentials

City Telephone ( Business Tele ;

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State

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Title/Position Current Title Mailing Address: Preferred Ma

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El Business

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Membership Category:

D Active

D Associate

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Who offered you this membership opportunity?

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Name _ _ Mail or fax completed form with payment to:

Enclosed Amount Encl D Check D Credit Card

Payment: Method of P~

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[ Credit Card Car, Use O n l y _ _

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// Account N u m b e r

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//Expiration Expiration Date: t/ Signature

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Society for Vascular Nursing 7794 Grow Drive Pensacola, FL 32514 (888) 536-4SVN (4786) Fax (850) 484-8762 Please note: Most membership mailings are sent at the nonprofit bulk rate. If mailing address is incorrect or incomplete, mail is neither forwarded nor returned to our office. Thus we have no way of knowing that you did not receive it. Please notify this office if your address changes during the year. The Society cannot be held responsible for mail that is not deliverable.