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Florida Nurses Foundation

Membership Application

In 1908, Theodore Roosevelt recognized the value of associations when he said: "Every man (woman) owes a part of his (her) time and money to the industry to which he (she) is engaged. No man (woman) has a moral right to withhold his (her) support from an organization that is striving to improve conditions within his (her) sphere."

We urge you to exercise your moral right and become a part of the working team that is the Florida Nurses Association. FNA- striving to improve conditions for nurses since 1909. We become stronger each time another nurse joins!

Membership is open to any licensed registered nurse (RN) in Florida. FNA dues include membership in the American Nurses Association (ANA) and your local District Nurses Association. Please check the appropriate dues category:

* indicates required fields.

Monthly Payment Method

ADP Option - Automated Bank Withdrawal (Available to Full Pay Members, State Only Members and FNSA First Time Renewal Members). Authorization is given to withdraw $24.59 per month for full pay members, $16.83 for state only members, $12.80 for FNSA First Time Renewal Members over one year or $7.00 for FNSA First Time Renewal Members over two years (which includes $1.00 service charge) on or before the 20th of each month. Included is the first month's payment for processing of further deductions. FNA is authorized to charge the amount by giving the undersigned thirty days written notice. The undersigned may cancel this authorization by written notification of termination to FNA within 30 days prior to deduction date.

Name of Bank:
Routing Number:
(9 digit number preceding the account number)
Account Number:
YES! I would like to donate MONTHLY to FNPAC!
Please deduct $: from my account.
YES! I would like to donate MONTHLY to the Florida Nurses Foundation!
Please deduct $: from my account.
Or Choose a Credit Card Payment Plan *
       (Employed full or part time under 65 years of age)

       (Employed full time or part time under 65 years of age)
       (Must be paid via credit card)

       Registered nurse seeking membership in the Florida Nurses Association
       only (no ANA direct benefits). Collective bargaining members are not eligible for this membership       category. If you work for the State of Florida, Wuesthoff Medical Center or Shands at UF, email to request the proper form.

FREE MEMBERSHIP DUES -> Free for the first year
       New Graduate FNSA members, FREE
       Basic nursing education program (first year only)

      Not currently employed
      Full time student
      FNSA First Time Renewal - One Year
      FNSA First Time Renewal Over Two Years - Must be ADP Deduction
      New Graduate Non FNSA member
      65 years of age or older and not employed


       (65 years of age or older and retired)

  One time FNPAC donation $

  One time Florida Nurses Foundation donation $

Credit Card Information *

American Express

Master Card
FNA has partnered with Capital One® to offer you three great credit card options. Not only can you enjoy solid card benefits, but with each use, you'll show your support of FNA too! Click here to apply for your card now and don't forget to use it for all of your purchases!

Credit Card Number:* 
Security Code:*  Click here to learn more.
Card Expiration Date:*
Name on Card:*
Send me a Receipt: Yes No
Comments/Promo Code:
General Information (Enter address related to credit card if paying by credit card)
Select Region:*

Northwest Region
      (Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Washington, Bay
       Gulf, Jackson, Calhoun, Liberty and Franklin)

North Central Region
      (Gadsen, Wakulla, Leon, Jefferson, Taylor, Madison, Lafayette, Dixie
       Hamilton, Suwannee, Gilchrist, Levy, Citrus, Columbia, Union
       Alachua, Marion, Bradford, Citrus)

Northeast Region
      (Baker, Nassau, Duval, Clay, St. Johns, Putnam)

East Central Region
      (Flagler, Volusia, Lake, Sumter, Seminole, Orange, Osceola, Brevard)

West Central Region
      (Hernando, Pasco, Pinellas, Hillsborough, Polk, Manatee, Hardee
       Highlands, Sarasota, DeSoto)

Southeast Region
      (Indian River, Okeechobee, St. Lucie, Martin, Palm Beach)

Southwest Region
      (Charlotte, Glades, Lee, Hendry, Collier)

South Region
      (Monroe, Broward, Miami Dade)

Special Interest Groups:
(Optional - Please indicate if you would like to join one or more of these Special Interest Groups)

New Graduates Nurses

Health Policy

Faith Community Nursing

Health Literacy

Nursing Research

Health Risk - various topics

Environmental Issues




Nurse Entrepreneurs

Staff Nurse Special Interest Group

License Number:*
If you do not have a license number, please use RN000000
Last Name;*
First Name:*
Middle Initial:
Street Address:
City, State ZIP

Renewing member - if your information has not changed, please click here to skip the fields in the following section.
Choose One: RN ARNP
What other organization(s) do you belong to:
Employer Address:
City: ZIP
Employer Phone:
I was referred by:
Graduate Nurse/FNSA ID#:
Date of Graduation:
Date of Birth:

FNA has partnered with Capital One® to offer you three great credit card options. Not only can you enjoy solid card benefits, but with each use, you'll show your support of FNA too! Click here to apply for your card now and don't forget to use it for all of your FNA purchases!


Note: Membership dues are not deductible as a charitable contribution, rather they may deductible as a business expense if you itemize your deductions. The exception is a portion of your FNA and ANA dues used for lobbying purposes that is estimated to be twenty five percent (25%). A portion of a members annual dues ($5) is automatically contributed to the Florida Nurses Political Action Committee unless by written request, the member designates this amount be paid to the FNA General Fund.