If you prefer to submit the form by mail or FAX or prefer to pay via check, please print this form, sign
and mail to the address below with payment enclosed

If the form is mailed, please include a separate sheet containing your
nursing education / work/homeopathic training and skills, energy, and ideas you have for HNA.

Name
Title
Street Address
City
State & Zip
Organization
Work Phone
Home Phone
FAX
E-mail
URL

Please provide the following credit card information. HNA dues are $40.00/year

	BILLING
Credit card	VISA MasterCard Discover
Cardholder name
Card number
Expiration date

Nursing Education / Work/Homeopathic Training
(Please use this section only if submitting this form electronically)

Skills, energy, ideas I have for HNA
(Please use this section only if submitting this form electronically)

Signature __________________________________________ Date ______________

Please sign above if this form is mailed

Homeopathic Nurses Assoc.
Sec’y / Treasurer: Margaret Easter
8403 Tahona Dr. Silver Spring, MD 20903
or fax #--508-223-1801

Highlight the above information* and then click here to this page and then click selection for the print range and click print!

*to highlight the information PC users need to right click and drag the mouse over all the contents you wish to print.  For Apple users you can simply click and drag the mouse over the text you wish to print.