TTC SNA MEMBERSHIP FORM      

Today’s Date: ________________

Name:  _____________________________________________________  

Address: ___________________________________________________

_________________________________________________

Phone:    ___________________________________________________

Email:      ____________________________________________________

Circle program track:         CNA         ADN        LPN

Expected Date of Graduation: ___________________________________

~ SNA has my permission to include this data in the SNA call tree for SNA purposes~  

Signature:  __________________________________________________

Circle t-shirt size:  Sm    Med     Lg      XL    

Please make checks payable to TTC-SNA in the amount of $40.00.  Submit check or cash along with the local and national application forms to the SNA mailbox located in the Student Activities Office, Bldg. 410, Rm. 130, or mail to:

                                                         Student Nurses Association

                                                          c /o Student Activities Office

                                                               P.O. Box 118067

                                                           Charleston, SC 29423-8067