|
NOTE: MoSALPN is now accepting payment through Paypal. Click here to access the Paypal version of this form.
To join MoSALPN, print this page and send with payment to:
MoSALPN
PO Box 105542
Jefferson City, MO 65110
Name __________________________________________________
Address ________________________________________________
City, State, ZIP ___________________________________________
(H) Phone _______________________________________________
(W) Phone _______________________________________________
Annual Fees:
_____ Regular Membership (LPN) $45.00
_____ Lifetime Membership $500 - Entire amount to be paid within five(5) consecutive months; a member may pay a one-time fee to maintain membership their entire life, with all rights and privileges.
_____ Associated (Retired/Disabled 5yr. member) $20.00
_____ Sustaining Member (Non-LPN) $20.00
_____ Legislative Fund $5.00
I have enclosed my: _____ Check _____ Money Order