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Individual Member Application

Welcome to the Washington State Nurses Association!

Please note: This application is intended only for nurses NOT employed in a position covered by a collective bargaining agreement between their employer and WSNA. If you work in a position covered by a WSNA collective bargaining agreement, please contact WSNA member services at (206) 575-7979 for the appropriate application.

To download a copy of the application or review the contents for more information please click the link below:
WSNA Individual Member Application

All fields marked with an asterisk (*) are required.

CONTACT

First Name

Middle Initial

Last Name

Street Name

Unit, Apt, #, etc.

City

State

Zip

Personal E-mail

Cell Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)

Last 4 of the SSN

Credentials

RN License #

Recent Graduate

NoYes

Gender

Race (Check all that apply)

Date Passed NCLEX

Date first employed as an RN

Birth Year

EMPLOYER

Employer Info

Employer

PAYMENT

Credit Card

Name

Type

Number (only digits without space)

CVV

Exp Month (mm)

Exp Year (yy)

Payment Plan

SIGNATURE