CNT Member Agreement & Premium Directory Listing Form

1. Are you a CannyNurse® Certificate Program Graduate?

Please note: you will need to upload your CNCP certificate below.

Yes

If yes, please proceed to complete the rest of the questionnaire.

We apologize, but you are not eligible for CNTribe membership at this time.

2. Your Name

Please write your name as you want it displayed, including your credentials, such as LPN, NC-BC, etc..

3. Business Name

If no business name, please write n/a.

4. Specialty Area(s)

Visit the Find A CannyNurse® directory (cannynurse.com/find-a-cannynurse) for examples.

5. Location(s) of Practice

Format: City, State or Province, Country

6a. Phone Number

Please include country code. For USA: +1 (999) 999-9999; for UK: +44 etc.

Calls or Texts

Calls Only

7. Type of practice

Telehealth only

(all appointments via phone or video conference)

Hybrid

(telehealth and in person appointments available)

Traditional

(in person appointments only)

8. Business email address

To be published in the directory.

8. Are you currently an annual member of CNN (Cannabis Nurses Network/ Conscious Nurses Network)?

Please note: CNN membership is REQUIRED to access our private members group.

Yes

Please pay for membership using this link: bit.ly/cntsilver2023

Please pay for membership using this link: bit.ly/cntsilverplus2023

10. Upload Headshot

Headshot displays best in cropped into a SQUARE. If photo is not cropped to a square, it's very likely your photo will look distorted. (File types allowed: png, jpg/ jpeg, heic. Limit 1 file no larger than 5mb.)

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11. Upload Proof of Education

Upload your certificate, degree, or other proof that you have met the educational requirement to join this program. (File types allowed: pdf, jpg/ jpeg, png, heic. Limit 5 files at 2mb each.)

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By checking this box and submitting this form, I understand and agree that this is an educational program with no guarantee of success. I also understand that if I register for a program I am not eligible for, my application will be rejected and I will not be able to access the CNTribe resources, information, and materials. CNN (Cannabis Nurses Network/ Conscious Nurses Network) annual membership is required to access our private member group. THIS APPLICATION is strictly for the membership directory listing. I understand I still need to submit PAYMENT at https://bit.ly/cntsilverplus2023 (or bit.ly/cntsilver2023 for current CNN members) within 2 weeks of submitting the form. If payment is not made, this application will be deemed abandoned and no further action will be taken by CannyNurse®. If I abandon my application, I understand I may resubmit it at a future date and pay whatever the current prices are at that time. Finally, I understand that CannyNurse® is a Registered Trademark and I agree NOT to use the trademarked term "CannyNurse®" (or any confusingly similar term) except to refer to myself as a "CannyNurse® Graduate" according to the usage rules specified by Ariana Ayu and CannyNurse®. I understand I may not use the word "CannyNurse®" (or any similar term that could cause confusion, including, but not limited to "canna nurse" or the like) in any business name, social media handle, website, or other manner that could cause confusion to the public.

I agree to the above agreement.