Application Type:
Name
Gender
Mailing Address
Employer/School
Telephone
Telephone type
Cell Phone type
Email
Declaration of Indigenous Identification
Indigenous Identification
Please note, non-Indigenous memberships have a different membership rate.
Upload requirements
Self-identify as an indigenous nurse by uploading the completed self-declaration form.
Upload requirements
Education and Experience
What are your nursing experience and credentials? (Choose highest level achieved)
Select areas of expertise and/or experience: