Affiliate Member Application

Contact Information

First Name*

Last Name*

Email*

Phone*

Address Line 1*

Address Line 2

Postal Code*

Province*

- AL AB AS AZ BC CA Geneva CO CT DC Dubai ENG FL Gauteng GA HI ID IL ZRL KS KY Malaga MB MD MA MI MS MO MT NV Nevis NB NJ NM NSW NY NZ NL NC NT NS NU OH OK ON OR P.E.I. PA PE QC QLD Saipan SK SA SCT SINDH SG SA SD TAS TN TX UT VT VIC VA WA WA WI YT

City*

Nurse Type*

RN - Registered Nurse RPN - Registered Psychiatric Nurse LPN - Licensed Practical Nurse Other - Other

Affiliate Type

Affiliate Type*

Student Nurse - I am currently studying to become a nurse Graduate Student Nurse - I have already graduated from a Canadian nursing program Internationally Educated Nurse (IEN) - I am an IEN without a BCCNM ID Other - I do not match any description above

Other Description

N/A

College/University

ABBOTSFORD VANC CAREER COLLEGE BCIT CAMOSUN COLLEGE CANADIAN HEALTH CARE ACADEMY CAP COLLEGE CDI COLLEGE COAST MOUNTAIN COLLEGE COLLEGE OF NEW CALEDONIA COLLEGE OF THE ROCKIES Discovery Community College DOUGLAS COLLEGE FRASER VALLEY UNIV COLLEGE KWANTLEN COLLEGE LANGARA SCHOOL OF NURSING MALASPINA UNIVERSITY NEW CALEDONIA COLLEGE/NRTH BC NICOLA VALLEY INSTITUTE OF TECHNOLOGY - MERRIT NORTH ISLAND COLLEGE Northern Lights College-Dawson Crk NWCC (PART OF UNBC) OKANAGAN UNIVERSITY COLLEGE OMNI COLLEGE SELKIRK COLLEGE SPROTT SHAW COMMUNITY COLLEGE STENBERG COLLEGE STERLING COLLEGE THOMPSON RIVER UNIVERSITY TRINITY WESTERN UNIVERSITY UNIVERSITY OF BC OKANAGAN UNIVERSITY OF BRITISH COLUMBIA UNIVERSITY OF NORTHERN BC UNIVERSITY OF VICTORIA UNIVERSITY-COLLEGE OF CARIBOO UNKNOWN COLLEGE VANCOUVER CAREER COLLEGE VANCOUVER COMMUNITY COLLEGE VANCOUVER ISLAND UNIV-NANAIMO Z_OUT OF PROVINCE

Campus

College/University

Country

Expected Graduation Date

Graduation Date

Student ID

Profession

How can we help?

How did you hear about the BCNU Affiliate Membership? (Check all that apply)

BCNU website

Nursing instructor/school

BCNU hosted student nurse presentation

BCNU conference sponsorship opportunity

BCNU student bursary application process

BCNU booth at conference

Social media

Fellow student

Other

Other (describe)

Would you like to receive print copies of BCNU's Update Magazine?

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* The update magazine is available digitally. Please visit the BCNU website.

I understand that by registering as a BCNU affiliate member, I am giving permission to the British Columbia Nurses’ Union to collect my personal information, including my name and email address. This information may be used by BCNU staff and BCNU regional representatives to share updates and information related to BCNU and the student nurse membership.

BCNU is committed to protecting personal information by following the Personal Information and Protection Act (PIPA), and other relevant privacy laws. For information about the collection, use, disclosure practices or opting out, contact BCNU’s Privacy Officer by mail at 4060 Regent Street, Burnaby, BC V5C 6P5 or email privacyofficer@bcnu.org.

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