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2008 SDONE MEMBERSHIP FORM
(Print off this page, complete, then mail with check to the
address below)
____ New Application
____ Renewal ____
Cancel Membership
____ Address Change
Name________________________________________Date____________________
( ) If no changes from last year check here. (No need to complete rest of
application.)
Home Address_________________________________ Phone___________________
City/State/Zip__________________________________ Email___________________
Employing Institution/Agency______________________ Phone___________________
Employer’s Address___________________________ Email___________________
City/State/Zip_________________________________ FAX___________________
In an effort to reduce mailing expense, you will receive SDONE
communication via email (at your workplace).
If you do not have an email
address, mailings will be done as before.
Your Title_______________________________________# Years in Position________
Educational
Background ____Masters
____BS or BSN
____Associate Degree
____Diploma
____Other
____Certification ______________________
Are you an AONE member? ____Yes ____No
Please send completed application form with $50.00 annual dues to:
Denise Muntefering
Avera St Benedict Health Center
401 W Glynn Drive
Parkston, SD 57366