Sign Up

Title:

First Name:

Last Name:

Password:

Confirmer le mot de passe:

Adresse résidentielle

Home Address:

City:

Province:

Postal Code:

Country:

Phone:

Adresse de la compagnie

Business Address:

City:

Province:

Postal Code:

Country:

Phone:

Extn:

Fax:

Cell Number:

Email ID:

Employer Name:

Job Title:

Registration Status:

Registered Nurse

Retired Registered Nurse

Student Nurse

Academic Credentials:

Institution Name:

Academic Credentials 2:

Institution Name 2:

Academic Credentials 3:

Institution Name 3:

Mailing Address:

Home

Work

Association des infirmières et infirmiers du Canada (AIIC)
Les membres actuels dans toutes les provinces à l'exception de l'Ontario & du Québec sont automatiquement membres de l'AIIC s'ils sont enregistrés comme infirmières ou infirmiers dans leur association provinciale / territoriale.

Are you a member of the Canadian Nurses Association (CNA)?:

Yes

Do you give permission to CHNC as a Canadian Nurses Association (CNA) Affiliate Member to share your contact details with CNA?:

Yes

CHNC Permissions

Do you consent to have your name and contact information shared with your provincial/territorial representative on the CHNC Board of Directors in order to be updated about CHNC activities or related provincial/territorial activities?:

Yes

Are you willing to have your contact details displayed to other CHNC members on the CHNC Member Directory? (Details will include: Name, Email, Business Name and Business phone number):

Yes

CONSENT FOR ELECTRONIC MESSAGES

Community Health Nurses of Canada values your relationship and wants to send you relevant and timely information. We do not share without your permission or sell our database or membership lists with any other parties. Do you consent to receive electronic messages about our resources, educational offerings, products, services, activities, events and other topics of interest?*:

Yes

Do you consent to receive text (SMS) messages about our resources, educational offerings, products, services, activities, events and other topics of interest? Messages will be sent to the "Cell Number" you have provided above:

Yes

Please note, you may unsubscribe from our electronic messages at any time by using the unsubscribe links provided.

Are you willing to participate in CHNC Board approved research activities?:

Yes

Raisons d'adhérer à l'IISCC (Veuillez cocher toutes les cases qui s'appliquent)

Why did you decide to join CHNC? (Please check all that apply):

Network with national colleagues

Be informed about national community health issues

Support development of practice guidance documents (standards and competencies)

Support advocoacy on health policy issues

Access to educational opportunities

Other

Any other reason

Champ d'intérêt principal en pratique de soins infirmiers en santé communautaire:

Primary Area of focus in community Health Nursing
CHECK ALL THAT APPLY:

Public Health

Home Health

Community Health

Education

Primary Care

Other (specify)

Any other area