Purchase NNPBC Membership 02: Contact Information

Purchase NNPBC Membership: Contact Information

NNPBC > Purchase NNPBC Membership 02: Contact Information

Contact Information
Name*
First name (official) Preferred name (if different from official) Last name
Home Address*
Street Address Address Line 2 City Province / State Postal Code Country
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Email address
Home Phone*
Mobile Phone (if different from Home Phone)
Designation*
Current nursing designation or past designation if retired.
What was your designation in your home country?*
What nursing designation are you currently pursuing in BC?*
Primary Employer
Years of Practice*
Please enter a number from 0 to 100.
Domain of Practice (1)*
Domain of Practice (2)
Do you identify as Indigenous (i.e., First Nations, Inuit or Métis)?
- Yes
- No
- Prefer not to answer
School Information
School
Program
Graduation Year
Student ID #
Professor/Teacher Reference Name
Communication Preferences
Allow Councillor
- I give NNPBC consent to share my contact details with my local NNPBC Councillor for communications purposes.
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Contact Information