2016 NSWS Annual Convention

Saturday, April 23, 2016 from 8:15 AM 4:30 PM (Pacific Time)

Lake Washington Institute of Technology

Student Registration Form

________________________________________________________________________________
Name

_________________________________ __ RN Student __ Pre-RN Student __ Other ________

School

________________________________________________________________________________
Address

City

State

Zip code

__________________________________________ ______________________________________
Email

Phone

Are you a member of a Student Club at your school? __ Yes __ No

Are you a member of NSWS? __ Yes __ No ________________________________________
NSNA Membership Number
-Not an NSNA/NSWS member? No problem! Become a member at NSNA.org!
*** Please note that all information collected will be for convention planning purposes only, and will not be given or
sold to other organizations, corporations, or agencies. If there are any concerns regarding confidentiality, feel free
to contact the NSWS board at nsws.officers@gmail.com. ***

Attendance is $25 for members and $30 for non-members and will include access to all
convention activities and a box lunch at the convention!
___ Member Admittance:
$25.00
___ Non-Member Admittance: $30.00
___ Check Enclosed
___ Visa/Mastercard
_______ - _______ - _______ - _______ ____ / ____
Credit Card Number

Exp Date (Mo/Yr)

To register online please visit http://www.regonline.com/2016NSWSConvention

If there are any questions or concerns regarding the convention, registration, or NSWS in general, please
feel free to email nsws.officers@gmail.com.

Return to:
NSWS Convention Registration
c/o Heather Stephen-Selby
Washington State Nurses Association
575 Andover Park West, Suite 101
Seattle, WA 98188