10 YEAR PREMIUM INDIVIDUAL MEMBERSHIP Price: $350 First Name:* First Name Required Last Name:* Last Name Required Email:* Email is Required Mobile Phone:* Mobile Phone is Required Street Address:* Street Address is Required City:* City is Required State:* State is Required Zip code:* Zip code is Required Gender:* Gender is Required Male Female Other Prefer not to answer Birth Date:* Birth Date is Required -----------------12345678910111213141516171819202122232425262728293031 Birth Month:* Birth Month is Required -----------------JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Highest Degree earned:* Highest Degree earned is Required Credentials:* Credentials is Required Speciality Certification: Speciality Certification is not valid Advanced Practice Provider:* Advanced Practice Provider is Required Nurse Practitioner Clinical Nurse Specialist Nurse Midwife Nurse Anesthetist Not applicable How would you like to be involved in IANANT?:* How would you like to be involved in IANANT? is Required Professional networking Continuing education activities Mentoring Career advancement self-help group Committees/Leadership Community outreach activities Not at this time Position Description:* Position Description is Required Nurse Clinician / Staff Nurse Nurse Informaticist Academic Educator Managers / Coordinator Nurse Scientist Staff Educator Patient Educator Clinical Trial Nurse Quality Improvement Director VP / CNO / CEO Consultant Entrepreneur Nurse Navigator Nurse Practitioner Retired Other Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger Description Amount Life Member – Payment $350.00 Total $350.00 STRIPE Pay with your Credit Card via Stripe Checkout Javascript is disabled in your browser. You will not be able to complete your purchase until you either enable JavaScript in your browser, or switch to a browser that supports it. No val Please fix the errors above
