Language
English (US)
OKVAN Registration:
Complete the form below to sign up for OKVAN membership or register for a quarterly OKVAN meeting.
Name
First Name
Last Name
E-mail
Phone Number:
-
Area Code
Phone Number
Licensure:
RN
RRT
APRN/PA
MD/DO
Other
Where did you hear about us?
A friend, coworker or colleague
Facebook
Email
Please check all that apply.
Current AVA member
Current VA-BC certification
Send me more information about AVA
Employer Information:
Employer Name, City
Employer
City
Employer Type
Hospital
Home Health
Long Term Care
Industry
Suggestions or topics you would like to be included in a future meeting?
Membership:
My Products
Current OKVAN member, quarterly meeting registration
$
Free
Meeting date
Decemember 12th, 2019
Quarterly meeting only (non-members)
$
15.00
Meeting date
December 12th, 2019
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Privacy Policy:
OKVAN respects the privacy rights of all individual members. Limited information provided on your application will be published on our online OKVAN Membership directory. If any member does not want their membership information published, that individual should submit a written request to oklahomavan@gmail.com.
*
I have read, understood, and accepted the PRIVACY POLICY for membership.
Submit
Should be Empty: