OSNA Membership Application

To become an OSNA member, please fill out this application, submit, and pay by check (made payable to OSNA) or cash. Payment can be made by dropping off payment at the OSNA Office, 5724 Dunn Hall, Orono, ME 04469-5724

Membership will not be active until payment is received
To submit a paper application, you may print this form or pick one up at the next OSNA meeting.

Today's Date:

Last Name First Name Middle Initial

School Address

City State ZIP

School Phone Cell Phone

School E-Mail Address

Home Address

City State ZIP

Home Phone Work Phone

Home E-Mail Address

Expected Graduation Date (Month and Year)

Are you already an NSNA member? Yes No (apply separately online at www.nsna.org or ask us for an application)

Method of Payment ($10.00 per year):
Check # Cash

Last updated 17 October 2005

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The University of Maine , Orono, Maine 04469
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A Member of the University of Maine System