AIGNA Corporate Membership Form 2018

AIGNA Corporate Membership Form 2019

Corporate Membership is available to all relevant organisations and costs €350 - this entitles 4 staff members from the organisation to attend the Annual Conference and the Masterclass. We require a named nurse for membership purposes to complete this form on behalf of the organisation. By return an invoice for payment will be sent to you for immediate payment in advance of the annual conference.
Full Name of Organisation*
Named Nurse*

First NameLast Name
NMBI Pin No*
E-mail*
Job Title / Grade*
If you selected other please specify
Address for Correspondence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone Number

Area CodePhone Number
Mobile Telephone Number*
Service Sector*
Once you have completed this form please press the submit button. You will shortly receive an invoice by email requiring immediate payment.
Exhibitors supporting our events may request members contact details - please tick this box if you don't wish us to share your details with them

Don't share my contact information
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AIGNA Corporate Membership Form 2019