Champions For Nursing Partnership Program

Champions For Nursing Partnership Program

Apply to become a Champion for Nursing partner. Please provide your company details and contact information below to join the program.
Company Name*
Company Website*
Company Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Company Description*
Upload Company Logo(s) (300 DPI, PNG or ESP)*

Cancelof
Main Contact Name*

First NameLast Name
Main Contact Email*
example@example.com
Main Contact Phone Number*
Please enter a valid phone number.
Agreement:

By checking this box, the party listed on this form agrees to the TNA Champions for Nursing Partnership Program terms listed on the TNA website. If the invoice option is selected, TNA staff will send an invoice, payable within 30 days of receipt, to the email address listed in this form. All payments are non-refundable.
How would you like to pay?*

Pay today with Credit/Debit CardPlease Send me an Invoice.

My Products

Friend Partnership

$500.00

Supporter Partnership

$1,000.00

Ally Partnership

$1,500.00

Advocate Partnership

$2,000.00

Total

$0.00

Partnership Levels*

Friend Partnership ($500)Supporter Partnership ($1,000)Ally Partnership ($1,500)Advocate Partnership ($2,000)
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