Membership Form

All information collected is stored securely and will not be shared outside of the CPCNA.

The information collected below will be used exclusively for the purpose of the work of CPCNA . We will not share your information with third parties.

If you are unsure which membership type applies to you, please email cpcnamembers@gmail.com before purchasing to avoid having to refund and submit correct payment.

Membership fees are due annually (January to December):
- Full Nurse Membership- $100 (plus transaction fees- $103.30)
  - Full Membership for Nurses in a Graduate Program - $50 (plus transaction fees- $51.75)
  - Full Membership for New Nurse Graduates - $50 (plus transaction fees- $51.75) (in first year of employment after graduation)

Entry to Practice Program Student membership- Free (includes entry to practice students and internationally educated nurses awaiting license to practice in Canada-

Admin Use Only

First Name

Street Address

Postal Code

Position/Role

Province/ Territory of practice

Last Name

City

Province

Year of Licensure

Practice Registration Number (School of Nursing if student) (Retired/non-practicing, enter 555555)

Enter certification number

Areas of Interest/Interest in Committees

I agree contacted by CPCNA

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