Join / Renew We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Name* First Last OrganizationDate Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Would you like to volunteer to be on an NLI or IALN committee? Education/Conference (NLI) Academic and Practice Partnerships (NLI) Individual Membership Price: $100.00 Quantity: Student membership Price: $50.00 Quantity: Must be currently enrolled in an undergraduate, masters or doctorate nursing programAffiliate Membership Price: $500.00 Quantity: Supporter Membership Price: $1,000.00 Quantity: Organizational membership for Schools of Nursing Price: $750.00 Quantity: Org membership for Critical Access Hospitals Price: $300.00 Quantity: The IALN awards scholarships to Idaho nursing students every year. Would you like to make a contribution to our scholarship fund?No Thank YouContributeContributeContributeTotal $0.00 Payment Method*Credit CardCheck(Please make checks payable to IALN, our charitable organization) Send this completed form and payment to: Idaho Alliance of Leaders in Nursing, 615 N. 7th St., Boise, Idaho 83702. If you have any questions, please contact Margaret Henbest, 208-367-1171, Mhenbest@nurseleaders.org 2012 Membership Data