Select Province

Please select...**Out of Country**AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Membership Category

Regular Membership: Nurse Practitioner registered to practice in Canada.

Associate Membership: Retired Nurse Practitioner (or) holds RN/NP registration outside of Canada.

Associate Membership - NP Student: NP Student (must provide educational institution and completion month/year).

Membership Category

Regular Membership (Block): Nurse Practitioner registered to practice in Canada.

Regular Membership (Block): Nurse Practitioner registered to practice in Canada.

Associate Membership - NP Student (Block): NP Student (must provide educational institution and completion month/year).

Regular Membership (Block): Nurse Practitioner registered to practice in Canada.

Associate Membership - NP Student (Block): NP Student (must provide educational institution and completion month/year).

Regular Membership (Block): Nurse Practitioner registered to practice in Canada.

Associate Membership (Block): Retired Nurse Practitioner (or) holds RN/NP registration outside of Canada.

Associate Membership - NP Student (Block): NP Student (must provide educational institution and completion month/year).

Institution

Please select...* Other:Athabasca UniversityDalhousie UniversityLakehead University—Parent InstitutionLaurentian University / Université Laurentienne—Parent InstitutionMcGill University—Parent InstitutionMcMaster University—Parent InstitutionMemorial University of Newfoundland—Parent InstitutionQueen’s University—Parent InstitutionRyerson University—Parent InstitutionSaskatchewan Institute of Applied Science and Technology (SIAST)—Parent InstitutionThompson Rivers UniversityUniversité de Moncton—Parent InstitutionUniversité de Montréal—Parent InstitutionUniversité de SherbrookeUniversité du Québec - École nationale d’administration publique—Parent InstitutionUniversité du Québec à ChicoutimiUniversité du Québec à MontréalUniversité du Québec à RimouskiUniversité du Québec à Trois-RivièresUniversité du Québec en Abitibi-TémiscamingueUniversité du Québec en OutaouaisUniversité LavalUniversity of Alberta—Parent InstitutionUniversity of British Columbia—Parent InstitutionUniversity of CalgaryUniversity of Manitoba—Parent InstitutionUniversity of New Brunswick—Parent InstitutionUniversity of Northern British Columbia—Parent InstitutionUniversity of Ottawa / Université d’Ottawa—Parent InstitutionUniversity of Prince Edward IslandUniversity of Saskatchewan—Parent InstitutionUniversity of Toronto—Parent InstitutionUniversity of VictoriaUniversity of Western Ontario—Parent InstitutionUniversity of Windsor—Parent UniversityYork University—Parent Institution

Name of Institution

Type of NP Program

Please select...AdultFamily-All Ages/Primary HealthCareNeonatalOther NP program not listedPediatric

Education Level

Please select...Bachelors (BN, BSN, BScN)Doctorate (DNP, PHD)Masters (MN, MSN)Other Degree:

Education Level (Other)

Year Started

Year Completed

Address

Country

Please select...AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAt SeaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicCzechoslovakiaDemocratic YemenDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland Islands (Malvinas)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGerman Democratic RepublicGermanyGermany, Federal Republic ofGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIreland, Republic of (EIRE)Isle of ManIsraelItalyJamaicaJapanJerseyJohnston AtollJordanKazakhstanKazakstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMidway IslandsMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayNot StatedOmanPakistanPalauPalestinian Territory, OccupiedPanamaPanama Canal ZonePapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarR_unionRomaniaRussian FederationRwandaSaint Barth_lemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSikkimSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S.S.R.UgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUnited States Miscellaneous Pacific IslandsUpper VoltaUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamVietnam, Democratic Republic ofVietnam, Republic ofVirgin Islands, BritishVirgin Islands, U.S.Wake IslandWallis and FutunaWestern SaharaYemenYemenYugoslaviaZaireZambiaZimbabwe

Province

Please select...**Out of Country**AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

City

Postal Code

Province/Territory of RN/NP Registration

Please select...**Out of Country**AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

RN/NP Registration #

Professional Registration

Continuing Education

Advocacy and Leadership