Student nurse membership application

New or renewal?
Please choose an option:
Personal information
First name:
Last name:
NZNO member number:
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Email address:
Confirm email:
Street address/PO Box (for receipt of Dissector Journal only):
Suburb:
City or region:
Postcode:
Perioperative Nurses College region:
Preferred contact phone number:
Ethnicity:
If you selected 'Other' above please state your ethnicity here:
Gender:
Place of nursing education (e.g. university or other tertiary education institution):
Year of education:
Regional involvement:
Age:
Any other information you may feel is relevant:
Confirm:

I have read and agree to the Terms & Conditions
Confirm:

I confirm I am eligible for Membership
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Hidden PNC email

New or renewal?