Registration – Irish General Practice Nurses Educational Association

Registration Form

Local Branch *
Please select your nearest County branch
Have you been a member of the IGPNEA within the past 2 years? *
First Name *
Surname *
Home Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Mobile Phone *
Tel (home)
*You must be working with a GP to qualify for membership. If you are doing Locum work, please name one GP you have worked for within the past 12 months
Name of GP Employer *
Work Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Tel (work) *
Would you like to receive text alerts from the National Executive Committee (NEC)?* *
PLEASE SELECT AN OPTION
Would you like to receive e-mail alerts from the National Executive Committee (NEC)?* *
PLEASE SELECT AN OPTION
*i.e. Relevant info via IPNA Admin, e.g. Alerts from health agencies, disease outbreaks, courses, discussion boards, etc.
Preferred mailing address for IGPNEA use (Including Journal) *
PLEASE SELECT AN OPTION
Do you give us permission to pass on your work contact details (Address and telephone number) to your local Professional Development Coordinator for Practice Nurses?
PLEASE SELECT AN OPTION
If you would like to receive communications from outside bodies (3rd Parties) on issues relevant to practice nursing, to your preferred mailing address, please tick here:
I would like to receive this information
This information may relate to education, study days, continuing professional development, products or services that are deemed by the National Executive Committee to be relevant to the role of the Practice Nurse.
Nursing & Midwifery Board of Ireland (formerly An Bord Altranais) PIN number *
Professional Qualifications (NMBI Divisions)
RGN
RM
RSCN
RPN
RMHN
RNID
RPHN
RNP

For website use

Email *
Repeat Email *
Choose a Password *
Membership Level *
Pending

Verification

Please enter any two digits with no spaces (Example: 12)*
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Registration Form

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