let yourself “evolve” by attending the · 2017. 11. 17. · let yourself “evolve” by...

Let yourself “evolve” by attending the 36th Annual DNA Convention

ADvANCe. Broaden your knowledge by attendingeducation sessions and workshops focusing on best practicesand new innovations in dermatology. Grow. Network with experts in the field and industryrepresentatives to enhance knowledge of current trends. expAND. Connect with trusted colleagues and meet newfriends at special events. ADD. Enliven your experience by exploring the sights thatSan Diego has to offer.

Who Should Attend?DNA is at the hub of a vibrant global network of dermatology careproviders. Attendees include registered nurses, nurse practitioners, licensedpractical nurses, medical assistants, other healthcare providers, and staffwith an interest in dermatology.

What’s in I t for You?The Dermatology Nurses’ Association is a professional nursingorganization comprised of a diverse group of individuals committed toquality care through sharing knowledge and expertise. You will expand andenhance your knowledge with the most up-to-date information about skinhealth and disease prevention measures.

Keynote SpeakerStephen Heitner, MBBCh (MD), FASE, FACC,specializes in caring for patients with uncommon andcomplex cardiac conditions. Dr. Heitner combinespassion and empathy for patients in a manner thatinspires all to want to be better in their individualefforts in patient care. His presentation will highlightways to bring the different specialists of medicinecloser together back in practice.

3 Register online | 2018.dnanurse.org36th Annual Convention

Dermatology Nurses’ Association evoLUTIoN: Yesterday | Today | Tomorrow

36th Annual Convention Goals and Objectives• Meet educational needs through dermatologic educational programs

based on feedback from previous convention, educational needsassessment, evidence-based practice, current guidelines, therapies, andresearch.

• provide workshop opportunities to meet the specific needs of specialinterest groups.

• provide an avenue for networking, mentoring, and socializing to enhanceprofessional growth of members.

• promote interest in dermatology-related fields, including safety, ethics,research, clinical testing, publishing, management, and advocacy toadvance dermatologic care.

The target audience is registered nurses, nurse practitioners, licensed practicalnurses, medical assistants, other healthcare providers, and staff with aninterest in dermatology.

DisclaimersSchedule is subject to change. Participation in these educational activities does not qualifyyou to perform the tasks presented, only provides a learning opportunity.

DNA’s contractors and attendees may be photographing or videotaping events at thisconvention. By attending the DNA 36th Annual Convention, attendees acknowledge theseactivities and agree to allow their image to be used by DNA in association publications, onDNA’s website, and in associated publications.



TUEsday February 13, 20183:00 pm – 7:00 pm registration open

Wednesday February 14, 20186:30 am – 5:15 pm registration open

7:00 am – 8:00 amproduct Theaters Seating is limited. Product theaters and breakfast will be provided if industry support isreceived.

8:00 am – 8:15 am president’s AddressDavid Schlichting, LPN

8:15 am – 9:15 am Keynote Address (1.0 contact hour)101 Amyloidosis and Clinical research in orphan Diseases

Stephen Heitner, MBBCh (MD), FASE, FACC

9:15 am – 10:15 amGeneral Session (1.0 contact hour)102 robin weber Immunology Symposium

Immunotherapy, the Next Generation of Skin Cancer TreatmentAANPGrace Chung, DNP, FNP-BC

10:15 am – 12:15 pm Grand opening of exhibit Hall

Join us for the official ribbon cutting ceremony to kick off the opening of the exhibit hall. Awide assortment of products, equipment, and services will be displayed by the leadingsuppliers of the dermatology industry.

12:15 pm – 1:30 pm Luncheon SymposiumSponsored by Regeneron/Sanofi

PDProfessionalDevelopment

SCOSurgical/Cutaneous Oncology

MPMedical/Pediatric

CLCosmetic/Laser

RResearch

Session Key

AANP = Pending American Association of Nurse Practitioners continuing education credit approval

2018 planning Committee Heather Onoday, BSN, MS, FNP-C, Chair

Susan Tofte, MS, RN, FNP-C, Nurse Practitioner Forum ChairDavid Schlichting, LPN, DNA President

Jaime Harvey, CMAOlanda Hathaway, CRNP

Ainsley Kullman, RNLaura Wavra, NP

Briana Wischnack, NP



1:30 pm – 2:30 pmConcurrent Sessions (1.0 contact hour)

2:30 pm – 4:00 pmexhibits open/poster viewing

4:00 pm – 5:00 pm Concurrent Sessions (1.0 contact hour)

5:00 pm – 6:00 pmproduct Theaters Seating is limited. Product theaters and light refreshments will be provided if industrysupport is received.

6:00 pm – 7:00 pm First-Time Attendee reception All first-time attendees are welcome. Join the DNA Board of Directors and the ProgramPlanning Committee for refreshments while networking with DNA leaders. Please select thisevent when completing your registration.

Thursday February 15, 20186:30 am – 5:15 pmregistration open

7:00 am – 8:00 amproduct Theaters Seating is limited. Product theaters and breakfast will be provided if industry support isreceived.

8:00 am – 5:00 pm Np Forum – Day 1 (See page 9 for full program. Additional fee.)

8:00 am – 9:00 amGeneral Session (1.0 contact hour)201 psoriasis Comorbidities: An evidence-Based overview

AANPLakshi Aldredge, MSN, ANP-BC

111 |AANP | MPCutaneous Lymphomas:Intersecting Clinical Careand Community, part 1Marianne Tawa, MSN, RN,ANP; Susan McCann, MSN,RN, DNC

112 |AANP | SCOMohs and reconstructiveSurgery for Common andUncommon Malignanciesof the SkinStanislav Tolkachjov, MD

113 |AANP | MPpharmacologicManagement ofDermatophyte Infections in HumansTheresa Coyner, MSN, NP;Katrina Masterson, DNP,RN, FNP-BC, DCNP

121 |AANP | MPAcne overview:epidemiology,Morphology, Treatment,and patient educationHeather Onoday, MN, RN,FNP; Sarah Neider, MA

122 | AANP \ MPAtopic DermatitisNoreen Heer Nicol, PhD,RN, FNP, NEA-BC

123 | PDposter presentationsMultiple nurses will presenttheir poster research.



9:15 am – 10:45 am exhibits open

10:45 am – 11:45 am Concurrent Sessions (1.0 contact hour)

11:45 am – 1:00 pm Lunch SymposiumSponsored by Amgen

1:00 pm – 2:00 pm Concurrent Sessions (1.0 contact hour)

2:00 pm – 3:00 pm exhibits open/poster viewing


4:00 pm – 5:00 pmGeneral Session (1.0 contact hour)240 practical Dermoscopy

AANPCaroline Kim, MD

5:00 pm – 6:00 pm product Theaters

Seating is limited. Product theaters and light refreshments will be provided if industrysupport is received.

211 |AANP | RThe research Team inDermatologyEric Smith, MST, MBA

212 MA Forum | PDSarah Neider, MA

213 |AANP | MPCase Study: Mortalityfrom Mismanagement of Skin InfectionBeth Haney, DNP, FNP-C,FAANP

221 |AANP | MPCutaneous Lymphomas:Intersecting Clinical Careand Community, part IIMarianne Tawa, MSN, RN,ANP; Susan McCann, MSN,RN, DNC

222 | AANP | SCOThe other Side of MohsSurgery: The LaboratoryTechnician’s perspectiveEric Smith, MST, MBA

223 | AANP | CLAesthetic TreatmentUpdates: Advances inCosmetic DermatologyBeth Haney, DNP, FNP-C,FAANP

231 | RFun in the Sun: The Use of Sunscreen on a CollegeCampusKatreena Collette-Merrill,PhD, RN; Emily Graham,LPN

232 | AANP | SCOUpdate on MelanomaOliver Wisco, DO, FAAD,FACMS

233 | AANP | CLHidradenitis Suppurativaand Use of Co2 Laser forTreatmentNicole VanHaaren, BSN,BBA, RN; Sherri Minchella,BBA, ADN, RN



MPMedical/Pediatric

CLCosmetic/Laser

RResearch

Session Key




Friday February 16, 20186:30 am – 5:30 pmregistration open

7:00 am – 8:00 am product Theaters

Seating is limited. Product theaters and breakfast will be provided if industry support isreceived.

8:00 am – 5:00 pm Np Forum – Day 2 (See page 10 for full program.)

8:00 am – 9:00 amGeneral Session (1.0 contact hour)301 Image rapid-Fire: High-Yield Dermatology Cases with Nursing Implications

AANPJonathan Miller, MD

9:00 am – 10:00 amGeneral Session (1.0 contact hour)302 TBD

To be decided

10:15 am – 11:15 am Concurrent Sessions (1.0 contact hour)

11:30 am – 1:00 pmLunch Symposiumpatient-Centered Treatment of psoriasis and psoriatic ArthritisLakshi Aldredge, MSM, ANP-BC, Panel ChairSponsored by Lilly USA, LLC


2:15 pm – 3:15 pm General Session (1.0 contact hour)330 pediatric Dermatology

AANPRobert Sidbury, MD

311 | AANP | M/PAutoimmuneMargaret Bobonich, DNP,CNP

312 | AANP | Rresearch-Based Nursingpractice to reduce SkinCancer Morbidity andMortalityVictoria Siegel, EdD, RN,CNS

313 | M/PSkin Manifestations ofDiabetes patientsKaren Fairbrother, BSN,RN, DNC, CDE

321 | TBD

322 | AANP | S/COHigh-risk Non-Melanoma Skin Cancer:pearls for ManagingComplex patientsR. Samuel Hopkins, MD

323 | AANP | M/Pocular and periocularMelanomaGera Mannor, MD, MPH



3:15 pm – 4:15 pm General Session (1.0 contact hour)340 Hair Loss: A practical Approach to Diagnosis and ManagementRita Pichardo, MD

5:15 pm – 6:15 pm DNA Business Meeting

All main convention attendees are welcome. DNA membership is not required to attend.

Saturday February 17, 20187:00 am – 12:00 pmregistration open

8:00 am – 12:00 pmDermatology Nursing Certification Board – Certification exam

8:00 am – 5:00 pm post-Convention workshops (7.5 contact hours)Additional fee. Continental breakfast included. 901 Dermatology Nursing essentials workshop

Noreen Herr Nicol, PhD, RN, FNP, NEA-BC; Theresa Coyner, MSN, NP; CynthiaHeaton, BSN, RN; Penny Jones, AGNP, CWCN-AP, CWS; Katrina Masterson, DNP,RN, FNP-BC, DCNP

902 Cutaneous Surgical workshopKellen Strickland, BSN, RN; Matthew Hand, MD; Justin Leitenberger, MD; SandeepSaluja, MD; Blake Sampson, MD; Oliver Wisco, DO, FAAD, FACMS

8:00 am – 10:00 am post-Convention workshop (2.0 contact hours)Additional fee. 903 Suturing workshop

Heather Onoday, MN, RN, FNP; Samuel Christensen, PA-C

10:00 am – 5:00 pm post-Convention workshop (5.5 contact hours)Additional fee. 904 Cosmetic workshop

AANPHeather Onoday, MN, RN, FNP



MPMedical/Pediatric

CLCosmetic/Laser

RResearch

Session Key




Nurse practitioner Forum (Additional fee)This educational activity will be submitted to the American Association of NursePractitioners for approval of up to 12.0 contact hours.

Two action-packed days of education targeted to the advanced practice nurse practitionerwith an interest in dermatology.

Thursday, February 15, 20187:00 am – 8:00 am product Theater

8:00 am – 9:00 am201 General Sessionpsoriasis Comorbidities: An evidence-Based overviewLakshi Aldredge, MSN, ANP-BC

9:15 am – 10:45 am exhibits open

10:45 am – 11:45 am214 TBDTo be decided

11:45 am – 1:00 pm Lunch Symposium

1:00 pm – 2:00 pm 224 Derm emergenciesJesse Keller, MD

2:00 pm – 3:00 pm exhibits open/poster viewing

3:00 pm – 4:00 pm234 pyoderma Gangrenosum and other Neutrophilic Dermatoses: A Case-BasedUpdateStanislav Tolkachjov, MD

4:00 pm – 5:00 pm244 Kodachromes: Case-Based review of Common and rare Dermatologic DiagnosesStanislav Tolkachjov, MD

5:00 pm – 6:00 pm product Theater

Two action-packed days of education targeted to the advancedpractice nurse practitioner with an interest in dermatology.

Nurse Practitioner ForumAdditional fee required



Friday, February 16, 20187:00 am – 8:00 am product Theater

8:00 am – 9:00 am 301 General SessionImage rapid-Fire: High-Yield Dermatology Cases with Nursing Implications Jonathan Miller, MD

9:00 am – 10:00 am304 NailsPhoebe Rich, MD

10:00 am – 10:30 am NpS Business Meeting

10:30 am – 11:30 am 314 DermatopathologyAnisha Patel, MD

11:30 am – 1:00 pm Luncheon Symposium

1:00 pm – 2:00 pm 324 TBDTo be decided

2:15 pm – 3:15 pm 334 Blistering DiseasesMargaret Bobonich, DNP, CNP

3:15 pm – 4:15 pm 344 Healthcare UpdateDavid Adelson, MD

4:15 pm – 5:15 pm 354 Advancements in psoriasis Management: evidence-Based Support for Best practiceLakshi Aldredge, MSN, ANP-BC

5:15 pm – 6:15 pm DNA Business Meeting

Nurse Practitioner ForumAdditional fee required



General InformationSheraton San Diego Hotel & Marina

1380 Harbor Island DriveSan Diego, CA 92101

The Sheraton San Diego Hotel & Marina hotel has been designated as the headquarters hotelfor the DNA Annual Convention. A block of rooms has been reserved at the special rate of$209 single/double. Rates are subject to applicable state and local taxes. Guest check-in timeis 3:00 pm. Check-out time is at 12:00 pm (noon).

To receive the convention rate, make online reservations through the DNA Convention website(2018.dnanurse.org) or call hotel reservations at 877-734-2726 and refer to the 2018 AnnualDNA Convention. The convention rate is available until Monday, January 15, 2018.Reservations received after this date will be accepted on a space and rate available basis.

parking (DNA does not validate parking)Parking is available with rates of $32 for self-parking and $37 for overnight valet parking.

TransportationThe Sheraton San Diego Hotel & Marina provides complimentary shuttle service to/from theSan Diego International Airport. The courtesy airport shuttle arrives every 20-25 minutes from4:45 am – 1:00 am, seven days a week.

weatherTypical temperatures in San Diego in February will get up to about 65 degrees during the dayand a low of 50 degrees in the evenings. Be sure to pack a sweater or light jacket or wear layersin the air-conditioned session rooms. We also suggest that you bring comfortable walking shoesfor your convention activities.

Convention Moderators NeededModerators play an important role in the overall success of DNA’s Annual Convention. Servingas a moderator is a great first-time volunteer role. Responsibilities include:

• Attending a brief moderator orientation on Wednesday, February 14, 2018• Introducing the speaker and making any housekeeping announcements• Monitoring questions from audience microphones• Helping to keep the speaker and session on time

To volunteer to be a session moderator, please check off this option when registering online.

Disclaimer: Please be cautious and aware that any solicitation you receive regarding housing servicesis coming from a third-party company that is not endorsed by or affiliated with DNA in any way.Room reservations made on your behalf by any outside company may not be guaranteed. DNA is notresponsible for any reservations made outside of the official hotel block.

product TheatersProduct theaters give you the unique opportunity to attend a session about specificproducts/services of interest in the comfort of a private, seated environment. These sessions aremeant to be promotional and do not offer any educational credit. Our exhibitors have beenoffered the opportunity to host one of the many product theaters taking place outside of theExhibit Hall. Seating will be limited.

privacy Disclosure Attendees of the DNA Convention are asked to register and provide some limited information.This data is submitted voluntarily. DNA asks attendees to provide their name, member number(for members), organization name, business phone, and email address.



Continuing education Information The Dermatology Nurses’ Association is accredited as a provider of continuing education bythe American Nurses Credentialing Center’s Commission on Accreditation.

Attendees may earn up to 15.0 contact hours for main convention sessions.

NP Forum: This education activity will be submitted to the American Association of NursePractitioners for approval of up to 13.0 contact hours of accredited education.

DNA is a group member of AANP, which entitles NP members to $10 off their membershipdues. Group #0503263

It is the DNA policy to fully vet and resolve any relative conflicts of interest disclosed by theplanners and presenters of this convention. Full disclosure will be available in the AnnualConvention Guide.

This convention is commercially supported by several commercial entities. A full listing ofcommercial supporters will be available in the Annual Convention Guide.

The Post-Convention Workshops and the NP Forum will be awarded contact hours separately.Contact hours may also be awarded separately for commercially supported educational symposiaif available.

Criteria for CompletionCredit is awarded for each session completed in its entirety. There is no partial credit awardedfor any session. Statements of credit will be awarded based on the participant’s attendance andsubmission of the activity evaluation form for each session. All participants will receive acontinuing education certificate via email upon completion of their online evaluation.

Speaker presentations/HandoutsDNA will post all available speaker presentations online prior to the convention. Attendeeswill be emailed a link to access the presentations. Attendees should download or printpresentations of interest prior to arriving at the convention. Workshop and NP Forum attendeeswill receive separate links to print out those handouts prior to the convention as well.

Upon check-in at registration, attendees will receive an annual convention guide, which willinclude all pertinent convention information, such as the schedule, room locations, andinstructions for obtaining continuing education credit. Speaker presentations will not beincluded.

SESSIONS – Please indicate your 1st & 2nd choice for each concurrent session and select optional activitiesyou plan to attend. On-site changes are permitted upon availability.

Wednesday, February 14 Thursday, February 15 Friday, February 1612:15 pm __ Lunch Symposium

1:30 pm __ 111 __ 112 __ 1134:00 pm __ 121 __ 122 __ 1236:00 pm First-Time Attendee Reception__ Yes __ No

10:45 am __ 211 __ 212 __ 21311:45 am __ Lunch Symposium

1:00 pm __ 221 __ 222 __ 2233:00 pm __ 231 __ 232 __ 233

10:15 am __ 311 __ 312 __ 31311:30 am __ Lunch Symposium

1:00 pm __ 321 __ 322 __ 3235:15 pm __ Business Meeting

Attendees are automatically registered for President’s Address, Keynote Address, and General Sessions.

Dermatology Nurses’ Association | REGISTRATION FORM

REGISTRATION FEESFULL CONVENTION (Tuesday, February 13 at 8:00 pm – Friday, February 16 at 4:15 pm) Includes all educational and socialactivities, excluding Post-Convention Workshops, NP Forum and any other additional registration fee selections.

Member Non-Member TOTALSuper Early Fee – On or before January 2, 2018 $350 $425 $

Early Fee – Postmarked January 2, 2018 through February 6, 2018 $400 $470 $

Regular/Onsite Fee – February 7, 2018 and after $435 $510 $

Student (Studying for RN degree – proof of enrollment required) $215 — $

One Day Only ___ Wednesday ___ Thursday ___ Friday $225 $265 $

Student One-Day Only ___ Wednesday ___ Thursday ___ Friday $120 — $

NP Forum (Thursday, February 15 – Friday, February 16)NP Forum Only (Both Days) $290 $355

NP Forum (One Day Only) ___ Thursday ___ Friday $255 $300

NP Forum & Full Convention – Super Early Fee – on or before January 2, 2018 $495 $540 $

NP Forum & Full Convention – Early Fee – Postmarked 1/2/18 through 2/6/18 $540 $625 $

NP Forum & Full Convention – Regular/On-Site Fee – 2/7/18 and after $580 $705

ADDITIONAL WORKSHOPS (Saturday, February 17)901 Dermatology Nursing Essentials $185 $205 $

902 Cutaneous Surgical $185 $205 $

903 Suturing Workshop $50 $55 $

904 Cosmetic Workshop $135 $150 $

Guest (other than attendee) for Exhibit Hall and Opening Reception – $50 Guest name _____________________ $

Total Amount Due $

PAYMENT OPTIONSCharge my: ___ Visa ___ Mastercard ___ American Express ___ DiscoverCredit Card Number ______________________________________________________________________

Exp. Date ______ Security Code* ______ * Last 3 digits, signature strip, back of credit card. American Express - Front 4 digits.

Name of Card Holder (please print) __________________________________________________________

Credit card billing address _______________________________________________________________

_____________________________________________________________________________________

Signature ______________________________________________________________________________

Cancellation PolicyCancellations must be submitted inwriting by midnight Tuesday, January30, 2018. Please e-mail your requestto [email protected] or fax to (856)218-0557. A $50 administrative feeapplies. All requests submitted afterJanuary 30 will not be honored. Allrefunds are pr ocessed after conven -tion. Membership nonrefundable/nontransferable.

Name Credentials

Employer/Organization

Preferred Mailing Address home work

City State Zip/Postal Code

Daytime Telephone home work cell

Required email address ___________________________________________________________To receive your receipt/confirmation, conference updates, and to log in for contact hours.

Disability or dietary needs? Please state: _______________________________________________________

3WAYS TO REGISTER

Mail with payment to:DNA Registration

East Holly Avenue, Box 56Pitman, NJ 08071-0056Fax payment with credit card info to:856-218-0557

Register online at:2018.dnanurse.org

(Credit card payments only)

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Join us at the36th Annual DNA Convention!

Great SpeakersOur top industry professionals will be presenting a wide array of topics!

NetworkingMeet with your fellow colleagues from around the world!

Unlimited FunThere are plenty of exciting things to do at our Annual Convention!

3 Ways to Register

Reserve your spot today!

t t t

ONliNe(credit card payments only)

2018.dnanurse.org

Fax(payment with credit card info)

856-218-0557

Mail(with payment)

DNa RegistrationEast Holly Avenue/Box 56 Pitman, NJ 08071-0056

The Dermatology Nurses’ Association is a professional nursing organization comprised of a diversegroup of individuals committed to quality care through sharing knowledge and expertise. The corepurpose of the DNA is to promote excellence in dermatologic care.

1. Professional Status:RNNPLPN/LVNMedical AssistantPhysicians Assistant

2. Employment:Full TimePart TimeNot EmployedRetiredStudent

3. Position:Staff NurseHead NurseClinical SpecialistSupervisor/CoordinatorInstructorAdministratorResearch NurseNurse PractitionerMedical Assistant

4. Practice Setting:Inpatient UnitOutpatient ClinicExtended Care FacilityCritical Care UnitPhysician’s Practice

Day Care UnitPhototherapy UnitDermatology SurgeryOther___________

5. Clinical Specialty:General PracticeAcneCosmetic DermatologyCutaneous OncologyDermatologic SurgeryGeriatricsPediatricsPhototherapyPsoriasisReconstructive SurgeryWound Healing

6. Highest Level ofEducation Completed:High SchoolDiploma-NursingAssociate NursingAssociate OtherBachelor’s NursingBachelor’s OtherMaster’s NursingMaster’s OtherDoctorate

7. Are you a member of the American Nurses Associations?(Check one)Yes No

8. YEARS IN DERMATOLOGYPRACTICE:(Check one)0-2 3-5 6-9 10-14 15-19 20+

9. Clinical Focus Groups:Cosmetic DermatologyCTCL/PhotopheresisOffice ManagementLasersMedical DermatologyPediatricsPhototherapyPsoriasisSkin Cancer/SurgeryClinical or Nursing

ResearchWound Care

10. How did you learn about the DNA?DermatologistDNA Chapter MeetingDNA Chapter EmailDNA Chapter Ad/Press Release

DNA Chapter Social MediaNetworkDNA ConventionDNA Member ReferralDNA WebsiteFacebookIndustry RepresentativeJDNALinkedInNursing School EventOther DNA EducationTwitterOther_____________

Additional questions forNurse PractitionerMembers:A. Area of NP SpecialtyCertification:AdultFamilyPediatricsWomen’s HealthGeriatrics

B. Area of Current Practice:General DermatologyDermatologic SurgeryCosmetic SurgeryPrimary Care

C. Does Your State:Require you to practicewith a supervising physician?Require you to practicewith a collaboratingphysician?Allow you to practice asa licensed independentpractitioner (LIP)?

D. What is the specialty of your supervisingphysician, if applicable:DermatologyPediatricsCosmetic SurgeryMoh’s SurgeryPathologyFamily MedicinePediatric DermatologyPlastic SurgeryCutaneous OncologyResearch

E. Do you haveprescriptive authority?(Check one)Yes No

435 N. Bennet StreetSouthern Pines, NC 28387800-454-4DNA • Fax 910-246-2361www.dnanurse.org • [email protected]

Dermatology Nurses Association Membership Application

Preferred Address (for membership and meeting materials to be mailed): Home Work

Name Credentials

Home Address

City State Zip Code

Telephone: Home/Cell

Email Address

Employer

Employer Address

City State Zip Code

Telephone: Work

Referred by (Name of DNA member)

DNA Membership Join or renew today and register atthe member rates! New Member RenewalNurse Practitioner • $135.00 (Membership includes NP Society)

License #_____________________ State __________

Nurse • $85.00 (RNs, LPNs, LVNs only)

License #_____________________ State __________

Associate • $75.00 Medical Assistant Physicians AssistantOther, Please specify______________________

Note: $12.00 of membership dues is applied to a subscriptionof the Journal of the Dermatology Nurses’ Association.

Check enclosed (payable to DNA in US funds)

Charge my AMEX M/C Visa

Card #__________________________________________

Exp. Date______________ Amount $_________________

Signature________________________________________

DNA occasionally makes available member information toorganizations and vendors that provide products and services ofvalue to the dermatology nursing community. If you prefer not to beincluded in these lists, please check the box provided.

DNA’s membership year is January 1-December 31. For the firstyear of membership, all new members will have an expirationdate of 12 months from the month joined. After the first year allmemberships expire on December 31. Thank you for yourmembership!

Please provide the following demographic information, if applicable. Check all that apply.

PRSR

TD STD

US POS

TAGE

PAID

PERM

IT 108

1BE

LLMAW

R NJ

East Ho

lly Avenu

e Box 56

Pitman

, NJ 0

8071

-005

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let yourself “evolve” by attending the · 2017. 11. 17. · let yourself “evolve” by...

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