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Minnesota Nurse Practitioners
PO Box 16332
St. Paul, MN  55105

 

Membership:  Join or Renew

 

Please provide all the information requested and return to MNNP with payment:

 

Name                     _______________________________________

 

Address                 _______________________________________

 

City, State, Zip       _______________________________________

 

Telephone             _______________________________________
 
Email                      _______________________________________

 

 

Choose membership type:

 

______1 Year Active Membership - $65


______3 Year Active Membership - $175 (a savings of 10%)


______1 Year Student Membership - $35 (verification necessary)


______Associate Membership - $50/year


 

Payment Type       ______Check        ______Credit Card

 

Card Type              ______VISA         ______Mastercard    ______Other(                   )

 

                                ______________Card Number    ________Exp

 

Date    ______Security Code(on back of card)

 

                                ___________________________Name as it appears on the card.

 

_________________________                                                 ___________________
Signature                                                                                        Date

 


Please print out this page then return fully completed form to MNNP with payment enclosed by US Mail.

 

PROOF of membership will be emailed to you.  If no email address is given, proof will be sent to the US Mail address on record.

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