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EXPLORE > Membership Information > Student Member Application

Student Member Application

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Professional Information
(The information in the section below will be used for the AIPN Membership Directory. Please enter it exactly as you would like it to appear. )
Prefix*
First Name*


Middle


Last Name*


Suffix


Email*


Alternate e-mail


I would like to receive emails about the following:



Regional Chapter Events and News







University*


Field Of Study*


Mailing Address*   Suite

 

City*


State/Province (US and Canada)
    Zip/Postal Code
 

Phone (Include country code if outside the US)*
   
country code area code   number

Fax (Include country code if outside the US)
 
country code area code   number

Country*


Region:



The information in the following sections will NOT appear in the Membership Directory

Username and Password
Please select a Website Username*

Please select a Website Password*


Education AIPN References
Undergraduate*


Major course of Study*


Year of Graduation*   Degree Rcvd*

 


Graduate 1


Major course of Study


Year of Graduation   Degree Rcvd
 


Graduate 2


Major course of Study


Year of Graduation   Degree Rcvd
 
  (Must be current AIPN active members)

Applicants for student membership need one(1) active AIPN member reference.


Name*


Email*


Attach Letter Of Enrollment


 
 
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