PHILIPPINE NURSES ASSOCIATION OF SAN DIEGO COUNTY, INC.
P. O. Box 881114
San Diego, CA 92168
Phone: (619) 235-5502
Website: www.pnasd.org

MEMBERSHIP APPLICATION:Date: __________________

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ADDRESS:_____________________________________________________
CITY:_____________________________________________________
STATE:_______________________      ZIP CODE: _________________

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WORK PHONE:________________________________________________
E-MAIL:________________________________________________

DATE OF BIRTH (Optional):  ______________________________________
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PRESENT EMPLOYER:__________________________________________
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SCHOOL GRADUATED FROM:
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Other personal information you wish to share:
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Fee To Enclose:  $50.00 if you are a new or active RN
  $40.00 if you are a retired RN
  $35.00 if you are an LVN
  $25.00 if you are an RN or LVN student

Send to:PNASD
P. O. Box 881114
San Diego, CA 92168

Membership expires one year after you joined/renewed.