This document is a membership application form for the Academy of Medical-Surgical Nurses of Nepal. The form requests information such as the applicant's name, address, citizenship number, highest nursing degree, registration number, years of nursing experience, specializations, current position, and membership fee payment details. It aims to collect relevant information to evaluate candidates for membership in the professional nursing organization.

1. Academy of Medical-Surgical Nurses of Nepal
(Professional National Nursing Organization of Nepal)
Kathmandu, Nepal
Membership Application Form
Registration Number/Date:
1. Name of Applicant:
2. Age/Sex:
3. Permanent Address: VDC/NP: Ward No.: District:
4. Working Address (office address):
5. Citizenship Number:
6. Name of Institute/Office:
7. Phone Number/Mobile Number:
8. Email ID:
9. Fax Number:
10. Highest Professional Nursing Degree:
11. NNC Registration Number:
12. Position/Designation (Current Position):
13. Total Number of Nursing Experiences (years):
14. Total Number of Medical-Surgical (Adult) Nursing experiences (years):
15. Any specialization degree or training taken in Medical-Surgical areas:
16. Current Working area/unit:
17. M.Sc. Nursing Completed/Studying Institute:
18. Membership Fee enclosed details(Rs./bank):
….……………………………………
Signature of the Applicant
Date: ……………………………….
For Official Use:
1. Payment details:
2. Approved by:
3. Membership Number Allocated:
Contact Address: Secretary, Academy of Medical-Surgical Nurses of Nepal, Kathmandu, Nepal
E-mail: amsn@gmail.com
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