OPNA Membership Request Form

Please Submit a Request to Become an OPNA Member!
In order to purchase a yearly membership to the Ontario Podortho® Nursing Association, we need to confirm eligibility.

First Name*

Last Name*

Email*

Phone Number*

Address*

Unit/Suite/Apt

City*

Province*

Postal Code*

Please upload confirmation of completion of your Podortho® Nursing Certificate or equivalent Foot Care Certification with Podortho Nursing Online Certificates. You are required to send in proof of Certificate and it will be verified by our Membership Director.*

Word Documents or PDF Only

Please Enter Your CNO Number*

(College of Nurses of Ontario)

Please list proof of practice liability insurance

(Separate with a comma)

List any other associations you're registered with

(Separate with a comma)

Independent Practice Information*

(clinic name, address, contact info, etc.)

Would you like to be added to our find a Podortho® Nurse tool listed on our OPNA website?*

Yes

Do you consent to completing your Podortho® Nursing Core Competencies within 12 months of your membership registration? I also hereby acknowledge that the membership fees for the Ontario Podortho® Nursing Association are non-refundable and non-transferable.
View Member Cancellation Policy*

I Acknowledge / Consent

This field should be left blank

Ontario Podortho® Nursing Association

Membership Request

OPNA Membership Request Form

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