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SOUTH DAKOTA
ORGANIZATION OF NURSE EXECUTIVES
Follow:
Membership Application
Type of application: *


 
Name: * 
Date: *  
Work Email: *  
In an effort to reduce mailing expense, you will receive SDONE communication via email (at your workplace). If you do not have an email address, mailings will be done.
Changes from last year?:
Home Address:
Phone: 
City/State/Zip:
Email: 
Employing Institution/Agency:
Employer's Phone: 
Employer's Address:
Employer's Email: 
Employer's City/State/Zip:
Employer's Fax: 
Your Title:
# Years in Position: 
Educational Background:



Certification:
Are you an AONE member?:
Name of SDONE member that brought you to the organization:
$50.00 Annual Dues, If you are a New Member or a student $25.00 for one year.
Print completed form and mail with payment to: Suzanne Campbell, SDONE Treas., Spearfish Hospital, 1440 N. Main Street, Spearfish, SD 57783
Address: Sioux Falls, South Dakota 57106
email: marie.rogers@sanfordhealth.org
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