The University of South Alabama
Student Nurses’ Association
Application for Membership
Date: ___________________
Expected Graduation Date:
Campus: **Pre-Nursing
Spring
Summer
Traditional
Fall
Accelerated
Year:_______________
Name: (Mr. / Ms. / Mrs.) _________________________________________
Jag No: J00_________
Street Address: _________________________________________
________Apt#: _____
City: ______________________________________
Phone: (
State: ______________
Zip: ___________
) ___________________________ E-mail: ________________@jagmail.southalabama.edu
What is the best way/time to contact you? _______________________________________________
If nominated, would you be willing to consider serving on a committee
or acting as an SNA officer?
YES / NO
If your financial situation and schedule permitted, would you have
interest in attending State or National activities, seminars, or conventions?
YES / NO
The Student Nurses’ Association does not discriminate on the basis of race, gender, sexual
orientation, or religious affiliation. Signing the application permits the SNA to contact you as
necessary to carry out the organization’s mission. Changes to information contained hereon
should be addressed to the Secretary (or Associate Secretary). Check or money order in the
amount of $35.00 should accompany this application. Membership term is one year, and enrolls
you in the University of South Alabama’s Chapter of the Student Nurses Association, the
Alabama Association of Nursing Students (AANS), and the National Student Nurses Association
(NSNA).
**Pre-Nursing: Check or money order in the amount of $20.00 should accompany this
application. Membership term is one year, and enrolls you in the University of South Alabama’s
Chapter of the Student Nurses Association
Send this form to:
Official Use Only:
USA CON
5721 USA Drive N. #3060
Mobile, AL 36688
Amt/Method Pd: _____________
Collected by: ________________
NSNA #: ___________________
Signature: _________________________________________________ Date: ________________________