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CPN Certification Kit Request Form
Thank you for informing nurses about PNCB's
Certified Pediatric Nurse (CPN) exam!
Due to the pandemic, PNCB staff will be working remotely and unable to process mailings. If you need materials, please contact
info@pncb.org
about our digital options.
Provide the details below and we'll send you a kit of our most popular materials to share with nurses. Allow 3 weeks for delivery. For U.S. and Canadian addresses only.
1.
How many pediatric RNs will you be informing? For requests higher than 100, email
info@pncb.org
with your event information and FedEx number to offset shipping costs.
2.
If you need your kit by a certain date, enter it below.
Please provide at least
3 weeks'
notice
. Orders needed sooner than
3 weeks
will be fulfilled as quickly as possible, but might not make your need-by date.
MM/DD/YYYY
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
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*
3.
What is your full mailing address?
(Required.)
Name:
*
Hospital/Healthcare Facility:
Address:
*
Address 2:
City/Town:
*
State:
*
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
*
Email Address:
*
Phone Number:
4.
What is your title/role?
5.
Do you need a small giveaway (e.g., pens or other item we provide) for these RNs?
Yes
No
6.
Are you interested in PNCB's No Pass, No Pay no-risk CPN testing program?
Yes, please contact me
No, we are not interested at this time
We already offer it
7.
Please share any additional information about your request below. Thank you for promoting CPN certification!
