: California Association for Nurse Practitioners

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Directory Preferences

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Alternate Contact Information

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Demographic Information

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Reason for Joining

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Professional Information

RN License Number

(This information is required for continuing education)

NP Certificate

Optional Donations

$100 CANP PAC One Time Contribution

$100

$50 CANP PAC One Time Contribution

$50

CANP PAC One Time Contribution

$

I do not wish to make a CANP PAC donation at this time.

Totals

Membership Dues:	$0.00
Discounts:	$0.00
Optional Donations:	$0.00
Final Total	$0.00

Upon submission of this application, I hereby agree to act in accordance with the Code of Ethics, Standards of Practice and bylaws of the California Association for Nurse Practitioners (CANP). I understand that failure to do so may result in the termination of my membership and that membership dues are non-refundable. I acknowledge that I will receive correspondence via email sent by or on behalf of CANP.

By selecting Auto Pay I hereby authorize CANP to initiate credit card charge(s) to the account provided. Authorization for such charges will remain in full effect until written notification from me is received by CANP and in accordance with the terms and conditions contained herein.

Pursuant to Federal Law, we must notify you that 25% of your dues are for lobbying expenses and are not tax deductible. The remainders of CANP dues are not tax deductible as a charitable contribution for Federal Tax purposes, but may be deductible as a business expense.

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Billing Information

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Terms & Conditions

By submitting this form you are authorizing your credit card to be charged for the indicated amount. Please see our Terms and Conditions page for further details. If you have any questions, please email admin@canpweb.org. Thank you for choosing the California Association for Nurse Practitioners.

Membership Application

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