FEES/ADVERTISING
EDUCATIONAL ACTIVITY FEE
ALL APPLICATIONS REQUIRE 60 DAYS FOR PROCESSING and THERE WILL BE A FIRST
TIME APPLICATION FEE FOR FIRST TIME APPLICANTS OF $75.00
MEMBER
$100
.5 – 3 Contact Hours
NON-MEMBER
$150
> than 3 - 7 Contact Hours
$175
$265
> than 7 - 16 Contact Hours
$200
$300
> than 16 Contact Hours
$280
$420
NEW LATE FEE SCHEDULE
ADDITIONAL LATE FEES FOR EDUCATIONAL ACTIVITIES AND APPROVED PROVIDERS
(Effective JANUARY 1, 2006)
30-59 DAYS
5-29 DAYS
1 - 8 Contact Hours
MEMBER
$100
NON
MEMBER
$150
> than 8 - 16 Contact Hours
$150
$225
$300
$450
> than 16 Contact Hours
$200
$300
$400
$600
Approved Provider
$200
$300
$400
$600
MEMBER
$200
NON
MEMBER
$300
ALL APPLICATIONS RECEIVED LESS THAN 5 BUSINESS DAYS WILL BE RETURNED
APPROVED PROVIDER APPLICATIONS – THREE (3) YEAR APPROVAL FEES
MEMBER
NON-MEMBER
$1,500 $2,250
for one non-profit organization with one Central CE Structure
$2,250
$3,375
$3,750
$5,625
$3,000
$4,500
for two non-profit organizations with one Central C.E.
Structure
for more than two non-profit organizations with one Central
C.E. Structure
for one for-profit organization
NJSNA CONTINUING EDUCATION MANUAL FEE
$
55
$
75
CE Approval Manual (Includes postage & handling)
Rental Agreement Between
New Jersey State Nurses Association and
Agency Requesting Membership List
MAILING LABELS
NJSNA membership mailing labels may be obtained for approved continuing
education offerings. Labels are rented on a one-time basis. A fee is charged for this
service. A formal request must be made in writing, and a signed agreement returned to
NJSNA before the labels can be ordered. As the labels are obtained from a national data
bank, sponsors should request this service at least three (3) weeks in advance of the
mailing date.
A master copy of the label agreement and policy can be found on the next page.
I hereby request that New Jersey State Nurses Association send its
membership list:
(please check one)



Entire State
Practice Area - _______________________________________________
Geographic Area - ____________________________________________
Pressure Sensitive Labels (Delivery will take approximately 3-4 weeks)
This rental agreement is for continuing education purposes on a ONE-TIME
ONLY BASIS. The renter agrees not to re-use, disclose, transfer, copy, reproduce, store,
or retain by any manner or means all or any portion of the mailing list, nor will renter or its
agents allow or permit any third party to do so. A sample of the brochure MUST be
attached.
The renter guarantees full payment of NJSNA 30 days after receipt of the bill. The
charge will be $150.00 per thousand for members of NJSNA and $250.00 per thousand
for non-members plus USPS Priority Mail costs. We have approximately 4000
members. There is an additional charge of $25.00 for selecting special categories. There
will be a shipping charge for overnight delivery requests. The association reserves the
right at its sole discretion to refuse rental or sale of the labels to the renter in which case
the association shall refund to renter its label fees paid to the association.
___________________________________
Print Name
___________________________________
Print Name of Organization
___________________________________
Street Address
___________________________________
City, State, Zip Code
___________________________________
Phone Number
______________________________
Signature
Date
NJSNA Member ID#_____________________
REQUIRED
ADMINISTRATIVE POLICY
NEW JERSEY STATE NURSES ASSOCIATION
PROCEDURE ON DISSEMINATION OF MEMBERSHIP LISTING
The New Jersey State Nurses Association will provide its membership list for
approved providers of continuing education plus individual requests approved by the
Associate Director on a fee for service basis.
1.
The fee will be such that there will be no cost to NJSNA.
2.
Use of the membership lists shall be limited to a one mailing only to publicize the
specific item for which it was requested and shall not be revised or disseminated to
other groups.
3.
The mailing list is not to be incorporated in any other lists nor duplicated,
reproduced or retained in any form or manner.
4.
All requests must be made in writing and the signed agreement returned.
5.
List Rentee guarantees full payment to NJSNA 30 days after receipt of the bill.
6.
NJSNA reserves the right to refuse release of its mailing lists for violators of the
policy.
Approved by NJSNA Board of Directors, 11/02
New Jersey State Nurses Association
1479 Pennington Road, Trenton, NJ 08618-2694
609-883-5335; 609-883-5343 (Fax) or Toll Free 888-876-5762
www.njsna.org
Recommended By:
Please Print or Type
Last Name
First
Home Address
Middle
City
Home Phone
State
Home Fax
Employer
City
Work Fax
Basic School/Nursing
Zip
County
Home Email
Address
Work Phone
Credentials
State
Zip
Work Email
License No.
Graduation Date
Nursing Specialty:
Legislative District:
Membership Dues Information: As part of your membership, $11.00 goes toward a subscription to the New Jersey Nurse. State nurse’s association dues are
not deductible as charitable contributions for tax purposes, but may be deductible as a business expense.
Check One Type:
M Full Annual Membership $298.00
 Employed full time or part time
R Reduced Annual Membership $153.00
 Not Employed
 Full-time student
 New Graduate from BASIC nursing education program within 12
months of graduation
(first year only)
 62 or over and not earning more than
Social Security System allows
S Special Annual Membership $80.50
 62 or over and not employed
 Totally disabled
Check Choice of Payment
___ E-pay (Monthly Electronic Payment)
This is to authorize monthly electronic payments to American Nurses Association, Inc. (ANA). By signing on
the line, I authorize ANA to withdraw 1/12th of my annual dues and any additional service fees from my
account.

CHECKING: Enclose a check for the first month’s payment; the account designated by the
enclosed check will be drafted on or after the 15th of each month.

CREDIT CARD: Complete the credit card information below and this credit card
will be debited on or after the 1st of each month.
Master Card ____ Visa ____ Card No. ______________________________ Expires ______
(Cards accepted through ANA)
_______________________________________ * SEE BELOW
Monthly Electronic Deduction Authorization Signature
___ Automated Annual Credit Card Payment
____UAN member? ____Not a Member of Collective Bargaining Unit
___________________________________________
Member of Collective Bargaining Unit other than UAN? (Please specify)
7% of your NJSNA annual dues is a voluntary contribution to the Interested
Nurses Political Action Committee. You may choose to decline to
contribute.

I decline, redirect this portion of my dues to the
General Fund.
Optional tax deduction gift payable to the Institute for Nursing/Foundation
of NJSNA (include a separate check). Funds donated to the Institute are
used for scholarships, education, and research.
This is to authorize annual credit card payments to American Nurses Association, Inc. (ANA). By signing
on the line, I authorize ANA to charge the credit card listed above for the annual dues on the 1st day of the
month when the annual renewal is due.
________________________________________________________* SEE BELOW
Annual Credit Card Payment Authorization Signature
___ Payroll Deduction: Available only where there is an agreement between your employer and the
Association to make such deduction. A $10.00 service fee will apply.
_____________________________________
Signature for Payroll Deduction
___ Full Annual Payment
Membership Dues ----------------------------------------------------------------- $_________
$25.00 donation or __________________
Thank you for your donation.
___ Check: Make payable to ANA
___ AMEX ___ DC ___ Master Card ___ Visa
(Cards accepted at State level)
To be completed by SNA (NJ):
Region __________
Exp. Date ________
___________________
Approved By
__________________
Date
Amount ____________
Check # _________
Member Type _______
Bill Type _______
Card No. ____________________________________________ Expires ____________
Signature: ___________________________________________
Printed Name: _________________________________________
*By signing the Monthly Electronic Deduction Authorization or the Automatic Annual Credit Card Payment
authorization, you are authorizing ANA to change the amount by giving the undersigned thirty (30) days
advance written notice. Undersigned may cancel this authorization upon receipt by ANA of written notification
of termination twenty (20) days prior to deduction date designated above. Membership will continue unless this
notification is received. ANA will charge a $5.00 fee for any returned drafts of charge backs.
Fax: 609-883-5343 (credit card payment) Or Mail to the above address.
New Jersey State Nurses Association
1479 Pennington Road
Trenton, NJ 08618-2694
609-883-5335 or Toll Free 888-876-5762
Fax 609-883-5343
www.njsna.org
Recommended By:
Please complete this application in its entirety
Last Name
Home Address
Home Phone
First
City
State
Email Address
Middle
Zip
County
Fax Number
Employer
Credentials
Work Address
City
State
Zip
Job Title
Certifications:
Specialty
License No.:
Membership in nursing organizations: Yes ___ No ___
Years in Nursing:
Please list:
7% of your NJSNA annual dues is a voluntary contribution to the Interested Nurses
Political Action Committee. You may choose to decline to contribute.
 I decline, redirect this portion of my dues to the General Fund.
____UAN member? ____Not a Member of Collective
Bargaining Unit
___________________________________________
Member of Collective Bargaining Unit other than UAN?
(Please specify)
Membership Dues Information: As part of your membership, a portion of your dues ($11.00) goes toward a subscription to the New Jersey Nurse. State nurse’s
association dues are not deductible as charitable contributions for tax purposes, but may be deductible as a business expense.
Form of Payment:


Make check payable to NJSNA for $130.00 and mail with application to the above address.
By Credit Card - $130.00 (Circle credit card used. Fill in number, expiration date, and signature)
Amex/DC/MC/Visa
Expiration Date
Signature
Optional tax deduction gift payable to the Institute for Nursing/Foundation of NJSNA (include a separate check). Funds
donated to the Institute are used for scholarships, education, and research.
$25.00 donation or $__________
Thank you for your donation.
The Official Newsletter of the New Jersey State Nurses Association
New Jersey Nurse is the official publication of the New Jersey State Nurses Association. The
newspaper reports on professional, economic, political, ethical, education, legal issues and events that affect
nursing in New Jersey.
The newspaper carries regular reports of continuing education courses for nurses and a feature on
legislative happenings in Trenton.
New Jersey Nurse carries news of the association, such as the annual convention, conference and
workshops, appointments, meetings, grants and awards. It carries member news both professional and
personal. Circulation…Rate is based on an average guarantee of 5200.
Editor...Andrea W. Aughenbaugh; Senior Editor...Sharon Rainer; Managing Editor...Sandy Kerr; Advertising
Editor...Sandy Kerr
Deadlines for articles in New Jersey Nurse
Deadline dates subject to change
Advertising Rates
ISSUE
DEADLINE
Page Size
1 Issue
3 Issues
6 Issues
January/February
December 21
Full Page
$875.00
$825.00
$765.00
March/April
February 21
½ Page
$495.00
$465.00
$435.00
May/June
April 21
¼ Page
$275.00
$265.00
$245.00
July/August
June 21
1/8 Page
$165.00
$150.00
$135.00
September/October
August 21
1/16 Page
$80.00
$75.00
$70.00
November/December
October 21
New Jersey Nurse Layout
Page Size
Dimensions
Full page
10”w x 15-3/4”h
1/2 page
7-3/4”w x 10”h
1/4 page
4-7/8”w x 7-3/4”h
1/8 page
4-7/8”w x 3-11/16”h
1/16 page
2-1/4”w x 3-11/16”h
New Jersey State Nurses Association,1479 Pennington Road, Trenton, New Jersey 08618-2694
Phone: 609-883-5335; Fax: 609-883-5343
Visit us at: www.njsna.org