Join or Renew Your Membership

You can join or renew your membership by completing this easy form!

First Name:

Last Name:

Credentials:

Title/Position:

VA Facility/
Organization/
Company:

Address 1:

Address 2:

City:

State:

Zip:

Business Phone
Number with
Extension:

Home/Cell
Phone Number:

Personal
Email Address:

Confirm Personal
Email Address:

Business
Email Address:

Confirm Business
Email Address:

Recruited By:

I am a first-time
Annual Meeting attendee Yes No

Registered Nurse Member: $150

LPN/LVN Member: $100

Emeritus (Retired) Member: $50

Associate Member: $250

Card Number:

Expiration Date
(mmyy):

Card Holder Name:

CVV
(# on back near sig):

You will have a chance to review your information before you finish.

Please review your form!
Make sure credit card expiration year is only 2 digits.
Make sure there are no dollar signs or commas.
Make sure there are no symbols like an ampersand, apostrophe, or letters with accents.

NOVA – Nurses Organization of Veterans Affairs

Join or Renew Your Membership

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