Pennpiano

Pennsylvania Indian American Nurses' Organization

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registration Form

Step 1 of 4

Basic Information

New Member

First Name*

Last Name*

Title Credentials*

Gender*

Male

Female

Upload Your Photo *

Highest Degree Earned*

Specialized in *

Home Address *

Phone Number*

Step 2 of 4

Work Information

Job Position*

other job detials*

Work place/Employer & Address*

Total years of professional nursing practice. after completion of initial nursing program *

Practice Area *

Ambulatory Care

Academia

Critical Care

Emergency Room

Geriatrics

Hemodialysis

Home Health

Interventional Radiology

Med-Surg

Operating Room

Rehab Center

Specialty Areas

Step 3 of 4

Other Information

Are you currently enrolled in a nursing program? If Yes, details:

If you had any nursing education in India, name your institution:

How would you like to be involved in PIANO? *

Professional networking

Continuing education activities

Mentoring

Career advancement self-help group

Committees/ Leadership

Community outreach activities

Other

Step 4 of 4

E-mail Address*

Password*

Repeat Password*

I have read and agree to the Terms and Conditions

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Pennsylvania Indian American Nurses' Organization (PIANO) is an organization of nurses of Indian origin residing in the state of Pennsylvania. PIANO is organized with unique vision and goals.

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Pennsylvania

secretary@pennpiano.com