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Name: *must fill field

Street Address: *must fill field

City: State: Zip: *must fill fields

Country: US Addresses ONLY

Preferred Phone: Home; Office; Cell;

E-mail: *must fill field

CURRENT NURSING ROLE: check boxes that apply

Student (School and Yr. of Grad.: )

Staff Nurse

Faculty (School: )

Administrator/Manager

Advanced Practice

Parish Nurse

Other

I am a current Journal of Christian Nursing (JCN) subscriber

I am in agreement with the NCF Purpose and Doctrinal Basis (*This box must be checked indicating agreement in order to process your membership application)

This is my first contact with NCF.

I have been involved with NCF in the past. Where?

I'm currently involved with NCF in my local area. Where?

MEMBER PARTNERSHIP:

• Membership Opportunities: (will be sent with Membership Card)
• I am in agreement with the NCF purpose and doctrinal basis
• The annual membership fee (US only) is $65 for practicing nurses, $50 for retirees, and $35 for full-time nursing students.
• Give gift to NCF ministry online

(Pay Membership Online takes you to the InterVarsity Christian Fellowship Online Store to process your payment.)

OR

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