Annual Membership Application
(January through December of each year)

If you would like to become a member of the Tallahassee Area Council of Advanced Practice Nurses (CAPN), please complete the CAPN Membership Application form (annually).

Benefits of CAPN membership:
     1.  Monthly dinner meeting with educational presentation
     2.  Opportunity to network with    colleagues
     3.  Listing in the CAPN directory of local advanced practice nurses
     4.  Eligibility to hold office in CAPN
     5.  $10 discount in individual AANP annual dues
     6.  Reduced registration fees to attend the annual conference

Dues:    
Dues for CAPN membership are $50/year; students and retirees: $25/year. You must be a CAPN member to be listed in the directory, to hold office, and to vote in the organization. Non-members of CAPN are welcome to attend the monthly meetings and CE presentations. The cost per meeting for non-members of CAPN is $10.00; students with documentation: $5.00. 

Continuing Education Credits:
American Nurses Credentialing Center (ANCC) re-certification requirements mandate that at least 50% of continuing education credits be from approved providers. CAPN is a member of the American Academy of Nurse Practitioners (AANP) to facilitate meeting this requirement. CAPN will provide 6-10 contact hours through AANP at the annual conference.

Please print or type. Information, excluding license number, will be listed in the directory.

Date ____________Name _______________________State License # ___________________

Home Address_________________________________________________________________
City/State/Zip _________________________________________________________________
Home Phone ________________________Home E-Mail _______________________________

Employer Name________________________________________________________________

Work Address__________________________________________________________________
City/State/Zip __________________________________________________________________
Work Phone _______________________Work E-Mail _________________________________

Highest Degree Held ____________ Area of specialization _______________
ARNP:
Specialty Area: Family ___ Adult ___ Pediatric_ __ Gerontological ___Psych/mental health ___
Other (please specify) ______Certification:  Yes___ No___ If yes, by whom:________________

CNS: ___Specialty Area_________________________________________________
Certified Nurse Midwife: ______ Certified Registered Nurse Anesthetist______
Graduate Student:  FAMU___FSU___Other___ Retiree___ Non-ARNP___

Make check payable for $50 (Students/Retirees $25) to Tallahassee Area CAPN.
Mail membership application and check to:
Tallahassee Area Council of Advanced Practice Nurses
P.O. Box 15892
Tallahassee, FL 32317    (If you do not wish to be a member of CAPN, but would like to be on our email list, please complete the above form and mail it to the above P.O. Box address).