Member Registration - The PNA - The Psychiatric Nurses Association of Ireland

First Name(*)

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Surname(*)

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Gender

FemaleMaleRather Not Say Invalid Input

Address(*)

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Email Address(*)

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Mobile Number(*)

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Date of Birth(*)

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Student Membership (MUST SELECT)(*)

YESNO Invalid Input

Previous or Current Union (If you are currently or have in the past twelve (12) months been a Member of another Union, please state which Union)

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Do you wish to stop your current union fees and join the PNA?

YESNONOT APPLICABLE Invalid Input

Grade(*)

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Qualifications

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Current Practice Address(*)

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Local Branch

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Are you a member of another Union’s Salary Protection Scheme?

YESNO Invalid Input

Payroll Officer (HSE Location)(*)

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Deduction Preference (SALARY DEDUCTION MUST EQUATE WITH YOUR SALARY PAYMENT PERIOD)(*)

Fortnightly €11Calendar Month €23.86Yearly €15 Associate Membership (Retired Nurses Only) Invalid Input

NMBI Pin Number(*)

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Payroll Reference Number(*)

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HSE Authorisation(*)

YESNO Invalid Input

By ticking this box I am consenting to PNA forwarding my personal data, as per this form, to the relevant HSE Area/ Employing Authority for processing union subscription, PNA Branch/Officer Board for general clearance purposes, inclusion in local & head office distribution lists and any representation purposes which may arise. If no, please let us know why in Other Info below.

Tick YES for PNA Plus discounts worth €710
Please note: Discounts are provided by Cornmarket who will contact you about PNA Plus.
By ticking Yes I am consenting to the PNA forwarding some personal data to Cornmarket for the purposes of inclusion in PNA Plus.
(*)

YESNO Invalid Input

Other Information

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Your Consent
The PNA Data Privacy Notice is available online here and by request from any member of staff or throughout the volunteer network. It is essential that you familiarise yourself with this policy as it details all aspects of how your data will be used by the PNA
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Yes - By ticking this box I am consenting to PNA forwarding my personal data, as per this form, to the relevant HSE Area, Employing Authority for processing union subscription, PNA Branch/Officer Board for general clearance purposes and any representation purposes which may arise and Cornmarket in the case of PNA Plus.No - By ticking this box I DO NOT consent to PNA forwarding my personal data, as per this form, to the relevant HSE Area, Employing Authority for processing union subscription, PNA Branch/Officer Board for general clearance purposes and any representation purposes which may arise and Cornmarket in the case of PNA Plus. Invalid Input
Please select your consent or decline consent for each element. If no consent is given, we cannot complete your online application, please contact us at Head Office.

Security (This is NOT case sensitive)(*)

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PNA Registration Form

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