AMERICAN SOCIETY FOR PAIN MANAGEMENT NURSING (ASPMN)
ST. LOUIS REGIONAL CHAPTER
MEMBERSHIP APPLICATION
Name: _________________________________________ Date_________________________
Current Position/Title:
___________________________________________________________
Home address:
_________________________________________________________________
City: _______________________ State: ___________ Zip: ____________
Home phone: ____________________________ Work phone: ________________________
FAX: __________________________________ Email address: _______________________
Institution:
____________________________________________________________________
Work address:
_________________________________________________________________
City:
_______________________________________State: ____________Zip: _____________
Speciality Area:
________________________________________________________________
Work Setting:
__________________________________________________________________
Preferred mailing address: ☐ Home ☐ Work
How did you learn about
ASPMN? _________________________________________________
You must be an ASPMN National
Member in order to become an ASPMN St. Louis Regional Chapter member.
National membership dues are: Active $95.00* (ASPMN, 7794 Grow Drive, Pensacola, FL 32514-7072). Application available at: www.aspmn.org/
Annual Chapter membership dues are: $25.00* Application available at www.aspmnstlouisregional.org/ (Checks payable to ASPMN St. Louis Regional Chapter, C/O Shriners’ Hospital for Children, 2001 S. Lindbergh Blvd, St. Louis, MO 63131, Attention Dorothy Stratmann-Lucey.)
*Both
memberships must be paid in order to be a member of the St. Louis Chapter.
**
There is a student membership available.
Reasons
to join ASPMN:
2-4 times a year Pathways publication
quarterly Pain Management Nursing Journal (really excellent!)
representation in Congress
NETWORKING!!!! REAL NETWORKING!!!
a member of an organization that works for patients across cultural and developmental dimensions
empowers nurses through education
plus much more!!!
If you
need to speak to someone please call Joan Wentz at 618-692-1231, or email her
at Jdomigan@aol.com/