ONLINE NCF GIFT MEMBERSHIP APPLICATION (USA only)

Request Membership Application Mailed

Use "tab" to move through the form.

GIFT RECIPIENT ("Ship To" information in the checkout process)

First Name: *must fill field

Last Name: *must fill field

Credentials:

MAILING ADDRESS

Street Address: *must fill field

City: State: Zip: *must fill fields

Country: USA Addresses ONLY

Preferred Phone: Home Office Cell

E-mail: *must fill field

CURRENT NURSING ROLE: check boxes that apply

Student (School/year of graduation: )

Staff Nurse

Faculty (School: )

Administrator/Manager

Advanced Practice

Parish Nurse

Other

MEMBER PARTNERSHIP:

Member Benefits: will be sent with Membership card
The annual membership fee (USA only) is
- $65 for practicing nurses
- $50 for retirees
- $35 for full-time nursing students
- $25 for under graduate students with JCN online-only access.

GIFT GIVER ("Bill To" information in the checkout process)

First Name: *must fill field

Last Name: *must fill field

E-mail: *must fill field

Preferred Phone: Home Office Cell

We will follow up with the gift recipient, letting them know you’ve given them a gift membership and sharing more about NCF. If you would prefer we send this message at a specific time, to make the gift a special surprise, etc., please share that information in the box below.

Pay Gift Membership Online takes you to the Online Store for InterVarsity Christian Fellowship to process your payment. Be sure to select the No shipping option as you check out. Your shipping costs are included in your membership payment.

Mail Membership application and check (to pay by check: Print this page and mail with your check to Nurses Christian Fellowship, P.O. Box 7895, Madison, WI 53707-7895)

PLEASE NOTE: that it can take up to 24 hours to process online payments through the InterVarsity store and up to 6 weeks to get your online access set up with JCN at the LWW website as they are a separate entity from NCF. However, if you need online access to JCN prior to receiving your LWW log-in, you can gain temporary access after your payment is processed by contacting ncf@intervarsity.org with your payment confirmation information - please send Order # and Order Date.