Personal Information
	* required Mailing Address & Phone Number(s)
Please Select:	Education: List pertinent credentials, certificates etc Registered Nurses are required to submit registration number followed by their province's initials, for example 7630037-ON, and Student Nurses are asked to submit their student number followed by their school's initials, for example, 9616285-UBC; retirees and other please enter XXXXXX-AA Registered Nurse Student Nurse Retired Registered Nurse Other  * required Please highlight if you are from one of the following provinces (who have international groups affiliated with CAIN): Alberta BC Other None of above
How do you want to be involved?
	Please Select Interested Areas of Involvement with CAIN: Write/Review Articles Committee Work Conferences Presentations Newsletter Research Consulting Work Proposals
	Areas of International Involvement, Experience    Or Interest:   Please DELETE following areas that AREN'T of International Interest/Experience for you: Environmental Health, Emergency Aid/Trauma, Infectious Diseases, Mental Health, Program Development, Nursing Leadership/Admin Support, Education, Community/Public Health & Health Promotion, Perinatal/Maternal & Child Health, Reproductive Health, Aboriginal Health, Primary Health Care, Epidemiology, Women's Health, Palliative/Hospice Care, Nutrition.   Please list geographic areas of experience &/or interest & any current projects/initiatives you are involved in:
Membership Type
	Regular Member - RN Associate - Retired Nurse Associate - Student Nurse Associate - Other
	Existing Member New Member

Regular Membership

Student Membership

Retired Registered Nurses

Non-Registered Nurse Associate Member