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Yes, I would like to join HNA

If you prefer to submit the form by mail or FAX or prefer to pay via check, please print this form, sign
and mail to the address below with payment enclosed

If the form is mailed, please include a separate sheet containing your
nursing education / work/homeopathic training and skills, energy, ideas you have for HNA.

Name
Title
Organization
Work Phone
Home Phone
FAX
E-mail
URL

Please provide the following credit card information. HNA dues are $30.00/year

BILLING
Credit card
Cardholder name
Card number
Expiration date

Nursing Education / Work/Homeopathic Training
(Please use this section only if submitting this form electronically)


Skills, energy, ideas I have for HNA
(Please use this section only if submitting this form electronically)


Signature __________________________________________ Date ______________

Please sign above if this form is mailed

Homeopathic Nurses Assoc.
Sec’y / Treasurer: Ann McKay R.N.,DiHom
4 Kellcourt Dr., Attleboro, MA 02703
or fax #--505-586-1169


Copyright HNA
Last revised: July 31, 2001

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