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Daytime Phone number*
Other Phone number
Email Address* (please use an email address that is unlikely to change)
Other (please specify)
Your business information will be displayed publicly. Your personal information will only be visible to other BCNPA Members
(*) Required Fields
Personal information will be available to BCNPA administrators/executive only.
Are you currently employed as an NP? *
Please provide your primary employer information
StudentPlease provide name of program:
Voting - Active Membership - Prorated Rate(Must hold a full, provisional, or non-practicing license as an NP)$120/year
Student – Non-voting(Proof of student status or student ID required)$90.00/year
Associate – Non-voting(Applies to registered nurses and general public interested in NP)$90.00/year
Your privacy is important to us. We do not and will not share or sell your personal information with third parties without your prior written permission and consent. Please be aware, we do share your e-mail address with BCNPA approved agencies (e.g. UBC Therapeutics Initiative, Do Bugs Need Drugs, etc.), and publish your employer work and contact information on the NP directory on our website to help the public find service in their area, and to assist NPs in finding one another.
Please check one:
I understand the above and allow BCNPA to share my e-mail address
with BCNPA approved agencies and organizations, and publish my employer work and contact
information to the BCNPA directory.
Please do not share my e-mail address to other agencies or publish
my employer work and contact information to the BCNPA directory.
Please submit your form electronically and send a cheque for the appropriate amount in full to:
27656 - 110th Avenue
Maple Ridge, BC
Name on Card*
Your CVV code is typically the last 3 digits in the signature box on the back of your card