Individual Membership Form

Step 1: Fill out the form below.

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Your Name *

Address

City

Country

Zip / Post Code

Phone *

Email *

Employer *

Your Job Title

Are you a member of a neonatal nursing organization?

YES
NO

If yes, please name the organization:

How did you hear about COINN?

Are you willing to act as a COINN representative for your area of the world?

YES
NO

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Step 2: Complete payment through PayPal.

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