Student Network Membership Form

Student Network Membership Form
  • id
  • date

  • First Name
  • Last Name
  • Current Student Program
  • Anticipated date of graduation
  • Age
  • Gender
  • Street
  • City
  • State
  • Country
  • Postal Code
  • Phone
  • Fax

  • Email

  • Homepage

  • Student Network Interest Area

  • Others (please specifiy)

    250 Characters left
  • Are you interested in being on a working group for these areas?
  • Do you belong to a National Nurses or Student Nurse Association in your country?
  • Would you like to contribute articles to the Student Network Bulletin?
  • User
  • Do you utilize student network chat room?
  • What is the best way to communicate with student nurses in your region? (please provide internet website links)
    500 Characters left
  • Any suggestions for program areas of the ICN Student Network?
    500 Characters left
  • Additional Information you wish to share?
    500 Characters left
  • Captcha

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