Verification of Registration Request

2208 E Victoria Ave
Regina, SK S4N 7B9
306-525-8026
registration@salpn.com

The purpose of this form is to verify to another regulatory board that you are, or were, registered with The Saskatchewan Association of Licensed Practical Nurses (SALPN). We will not send information to an employer or school.

Verification of Registration Request

Personal Information

First Name *

Last Name *

Registration Number *

Click here to look up your Registration Number

Email Address *

Address *

Address

City

State/Province

Zip/Postal

Regulatory Board Information

Name of Regulatory Board to receive your verification of registration *

Address *

Address

City

State/Province

Zip/Postal

Country

DECLARE: *

I hereby authorize the SALPN to release my registration history, examination scores, and any information related to my conduct and/or health that has been reviewed by the SALPN to the party identified above.

I understand the fee to process my verification of registration request is $50.00.

Signature of Member: *

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Date *

Payment Information

Card Type: *

Card Number:

Expiry Date:

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