AALNC Northeast Ohio / Cleveland Chapter
Join Our Chapter
To join our chapter or renew your membership please fill out the form below.

PLEASE NOTE: You must be a national AALNC member to belong and your membership number must be included for us to process your application. If you are not a national member and would like to apply, click here.

PAYMENT: Our yearly membership fee is $75.00 for independent LNCs and $50.00 for in-house, law firms LNCs, and student LNCs.
Please make checks out to Cleveland NEO AALNC and mail to:

AALNC NEO Chapter
PO Box 30435
Cleveland, OH 44130

APPLICATION: Please fill out the form below. If you are licensed in more than 3 states please provide additional license information in a separate e-mail to the address below. Please attach the information for your biography to be included in the yearly directory.

Questions and inquiries should be submitted to:

Debra Wilden
drm627@ameritech.net

Membership Application/Renewal Form

GENERAL INFORMATION

Name

First

Last
Credentials (e.g., BSN, RN, LNCC):
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number

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Fax Number

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Email
Confirm
Web Site
Name of Business/Employer

MEMBERSHIP INFORMATION

Membership Type:
 New Member 
 Renewal 
AALNC MEMBERSHIP NUMBER: (required for local chapter membership) *
Area(s) of clinical speciality:
Testifying Expert:
 No 
 Yes, indicate specialty(ies) 
Testifying Specialty(ies):

Please make checks out to CLEVELAND NEO AALNC

Payment
 $75.00 for independent LNCs 
 $50.00 for in-house, law firms LNCs, and student LNCs 

WEBSITE INFORMATION

Please enter a short bio and any other information you would like listed on the website here.
Checkbox *
 I certify that the above information is true and accurate. 
Sign and Date *
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