Ocean County School Nurses Association
MEMBERSHIP APPLICATION
Name:_________________________________________________________________
Home Address:__________________________________________________________
City:___________________________________________ Zip Code:_______________
Home/Cell Telephone Number: (
)______________________________________
Email Address:__________________________________________________________
School:________________________________________________________________
School Address:_________________________________________________________
City:___________________________________________ Zip Code:_______________
School Telephone Number (
)__________________________Ext.:____________
School Email Address: ___________________________________________________
School Fax_____________________________________________________________
□
□
Renewal
New Member
PLEASE CHECK ONE OF THE FOLLOWING



REGULAR MEMBER: Currently full time certified school nurse or supervisor employed by a
public Board of Education in Ocean
County…………………………………………………………………………………….$20.00
ASSOCIATE MEMBER: Non-certified school nurse, non-working school nurse enrolled in a
certification program, substitute school nurse, school nurse employed by a Board of Education
outside Ocean County or by a non-public school……………………………………………….$15.00
RETIRED MEMBER…………………………………………………………………………………$10.00
PLEASE SEND THIS COMPLETED FORM AND CHECK BY JUNE 30TH TO:
School Nurse Marella-OCSNA
North Dover Elementary
1759 New Hampshire Ave.
Toms River NJ 08755
MAKE CHECKS PAYABLE TO OCSNA, NO PURCHASE ORDERS OR VOUCHERS
ACCEPTED!
I am a member of the NJ State School Nurses Association for _______years.
I am a member of the National Association of School Nurses for ______years.
I am interested in helping on a committee_____________________________