ICNC Application

Chapters:

Alt Step 1: For Paying Annual Membership Dues Just for Renewal Members
Click/tap "RENEWAL PAYMENT" to proceed to the payment options web page without completing a new application. Do this unless your circumstances have changed. New employer? New position/title? New phone/other? If so, then please complete the standard Step1.

Renewal Payment

Step 2: Paying Annual Membership Dues -
Secure online (PayPal or charge card) payments
are accepted and the process will autocratically follow the submission of this renewal or new application.

If You Prefer? You Can Mail in Your Application

Download a blank copy HERE and print. Complete and include your $40.00 check for payment. Thank you.

Send a Copy of Your Application with Payment to:
Infection Control Nurses of CT
c/o Donna Wade
241 Hogan Rd
Hamden, CT 06518

Membership Application (Two Step - Process)

Instructions: Step 1 - Complete the Membership Application Form and "SUBMIT". Next, to pay the annual dues online you will be automatically guided to Step 2, the payment options.

If you are an existing member? Please see "Alt Step 1".

Step 1: ICNC Membership Application Form

* Indicates required field

Your Name *

First

Last

Credentials *

Position *

How Long in Position? *

Facility/Affiliation *

Facility or Work Address *

Line 1

Line 2

City

State

Zip Code

Country

Your Work or Contact eMail *

Work or Contact Phone Number *

Mobile (Cell) Number *

Fax Number *

Membership- Choose One *

New Membership Renewal

Joining With or A Member of - Select One *

Comment *

I agree to receiving marketing and promotional materials *

Submit

Note: Before you "Submit" print a copy for your records.
After submitting you will be guided to the payment options web page.

Thank You!