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Perioperative Nurses College
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Registered or Enrolled Nurse PNC membership application
In this area:
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The Dissector
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Registered or Enrolled Nurse membership application
New or Renewal?
Please choose:
I'm new to the College
I'm renewing my College membership
Personal information
First name:
Last name:
NZNO member number:
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Email address:
Confirm email:
Street address/PO Box (for receipt of Dissector Journal only):
Suburb:
City or region:
Postcode:
Perioperative Nurses College region:
Auckland and Northland
Central North Island
Ruahine and Egmont
Hawkes Bay / Te Matau a Māui
Wellington
Canterbury and West Coast and Nelson / Marlborough
Otago and Southland
Preferred contact phone number:
Ethnicity:
NZ Maori
NZ European
Samoan
Cook Island Maori
Tongan
Niuean
Chinese
Indian
Filipino
Other (please state below)
If you selected 'Other' above please state your ethnicity here:
Gender:
Female
Male
Gender diverse
Prefer not to disclose
Hospital or Workplace (please include full workplace name and address if your workplace is paying for your membership):
PRIMARY area of practice:
Aesthetic (Appearance Medicing) Nursing
Medical Imaging
Operating Theatres
Post Anaesthetic Care Unit
Surgical Nursing: Day Surgery Unit
Surgical Nursing: Outpatients
Surgical Nursing: Pre-assessment/ERAS
Surgical Nursing: Surgical Ward
Retired or Not Working
Other
Nursing role:
Advanced Nurse: Clinical
Advanced Nurse: Education
Advanced Nurse: Management
Nurse Practitioner
Enrolled Nurse
Registered Nurse
Student Nurse
Highest qualification:
Hospital Certificate
Diploma
Bachelor's Degree
Graduate Certificate
Postgraduate Certificate
Postgraduate Diploma
Masters
Doctorate
Additional areas of practice (choose as many as apply):
Anaesthetic Assisting
Critical Care
ENT
Education
Endoscopy
General Surgery
Gynaecology
Health and Safety
Infection Control
Maxillofacial
Military
Neurology
Ophthalmology
Orthopaedics
Paediatrics
Pain Management
Plastics
Renal
Research
RN Anaesthetic Assistant (RNAA)
RN First Surgical Assistant (RNFSA)
Scrubbing/Circulating
Sterile Services
Thoracic
Urology
Vascular
Areas of Interest/Expertise (choose as many as apply):
Procurement/consumables
Quality/standards/auditing
Working parties/projects
Cyber technology
Infection control
Advanced nursing practice
Regional involvement:
Want to be involved
Active involvement
Wish to assist with government submissions
Wish to assist with policy development
Would like further information
Not at this time
Years of nursing:
0 - 4 years
5 - 9 years
10 - 19 years
20 - 29 years
30 - 39 years
40 years and over
Age:
< 30 years
30 - 39 years
40 - 49 years
50 - 59 years
60 - 69 years
70 years and over
Any other information you may feel is relevant:
Are you a member of another NZNO College or Section?
Yes
No
What subjects would you like to read about in The Dissector Journal?
Additional comments:
Please tell us anything else you wish us to know:
Payment information
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Please bill me for the $20 annual Membership fee
Purchase order number:
Payment method
Credit card
Internet banking
Confirm:
I have read and agree to the
Terms & Conditions
Confirm:
I confirm I am
eligible for Membership
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