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Individual Member Application

Welcome to the Washington State Nurses Association!

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.

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

Employer

Name

Type

Number (only digits without space)

CVV

Exp Month (mm)

Exp Year (yy)

Payment Plan

Name