Friday, April 20, 2018          
Membership Purchase/Renewal

HPNA Members with a current membership receive an extra month added to their membership when renewing online!

 Personal Information 
First Name *
Last Name *
Middle Initial
Date of Birth *  mm/dd/yyyy format
Primary Email Address *
Secondary Email Address
Do you want to receive the free e-newsletter?
Your Age Group
Your Gender
Your Ethnicity
if Other, please specify:
Preferred Mailing Address
 Your HOME Information 
Address Line 1
Address Line 2
Zip/Postal Code
Home Phone
Cell Phone
 Your WORK/OFFICE Information 
Address Line 1
Address Line 2
Zip/Postal Code
Work Phone
 Professional Occupation 
What best describes your current occupation?
 Type of Practice
What best describes your type of practice?
if Other, please specify:
 Membership Information 
Discussion Communities (Special Interest Groups) are available to all HPNA members. Each community enables members to network and learn more about a specific topic via email.  Please indicate which Communities you would like to enroll in:  (these choices may be changed at any time)

May we distribute your contact information outside of HPNA?
 Additional Information 
HPNA Chapter or Provisional Group Member?
Highest Education
if CNA, specify State:
Primary Type of Care
if Other, please specify:
Primary Patient Age Group
Total Years in your profession
Primary Facility Location
Your Primary Role
if Other, please specify:
Your Primary Employer
if Other, please specify:
Your Primary Practice Setting
if Other, please specify:
Other Organization Memberships

 Membership Benefits 
What membership benefits would you like to see?  
Benefit 1
Benefit 2
Benefit 3
if Other, please specify:
 Optional Information 
How did you hear about us?
if Other, please specify:
 Membership Levels 
Following is a list of the current HPNA Membership fees
Membership Level / LengthFee
Associate (1 yr)$100.00
LPN/LVN (1 yr)$82.00
LPN/LVN (2 yrs)$140.00
Nursing Assistant(1yr)$50.00
Nursing Assistant (2yrs)$80.00
RN (1 yr)$115.00
RN (2 yrs)$210.00
Retired RN (1 yr)$60.00
Retired RN (2 yrs)$100.00
Student (1 yr)$55.00
RN-Student (1 yr)$70.00
International Membership(Code Required at Checkout)

Membership Level: 

Please indicate your JHPN preference: 

Note:  Print/Mailed subscriptions for the Journal of Hospice and Palliative Nursing (JHPN) are available for an additional fee ($14 for 1-year memberships; $28 for 2-year membership).  Effective January 1, 2016, all HPNA members receive FREE access to the online version of JHPN.  
Retired RN
memberships are only available those individuals Over 70 years of age and not currently employed in nursing.  If a Student membership is selected, the fields shown below are required.  (NOTE:  the Student rate is applicable for FULL-TIME STUDENTS ONLY!)
Notice:  7.1% of your membership dues are allocated tolobbying costs, and are therefore nondeductible as a business expense.  Please consult your tax advisor for further advice.
 Student Membership Information (disregard if not applicable)
Name of school/college
Title of Nursing program
Expected graduation date /
Please allow up to 24 hours
for membership purchases to be activated
and full member portal access.