HomeOur PurposeBecoming a MemberMembership ApplicationContact UsEvents CalendarBY-LAWSOCSNA Printable Meeting FlyerLinksSub Pay for School NursesESY PayNewsScholarshipLegislative News

OCEAN COUNTY SCHOOL NURSES ASSOCIATION 

MEMBERSHIP APPLICATION FOR THE SCHOOL YEAR OF_____________________                   

Name:_________________________________________________________________

Home Address:__________________________________________________________

City:___________________________________________ Zip Code:_______________

Home/Cell Telephone Number:  (         )______________________________________

Email Address:__________________________________________________________

School:________________________________________________________________

School Address:_________________________________________________________

City:___________________________________________ Zip Code:_______________

School Telephone Number   (        )__________________________Ext.:____________

School Email Address: ___________________________________________________

School Fax_____________________________________________________________

   □   Renewal                               □   New Member

This is a Change Since Last year   circle one                   Yes/ No

PLEASE CHECK ONE OF THE FOLLOWING

REGULAR MEMBER:  Currently full time certified school nurse or supervisor employed by a public Board of Education OceanCounty……………………………………………….$20.00

ASSOCIATE MEMBER:  Non-certified school nurse, non-working school nurse enrolled in a certification program, substitute school nurse, school nurse employed by a Board of Education outside Ocean County or by a non-publischool………………………….$15.00

RETIRED   MEMBER……………..…………………………………………………$10.00

PLEASE SEND THIS COMPLETED FORM AND CHECK TO:

Crystal Ruiz RN, MSN

2515 Hooper Ave

Brick, NJ 08723                                                                                                                                        

MAKE CHECKS PAYABLE TO OCSNA, NO PURCHASE ORDERS OR VOUCHERS ACCEPTED!

I am a member of the NJ State School Nurses Association for _______years.

I am a member of the National Association of School Nurses for ______years.

I am interested in helping on a committee_____________________________