Chapter List Rental Request Form

Interested in recruiting local members to your chapter educational event or as a chapter member? You can, through AACN’s List Rental Process. As an AACN chapter, you are entitled to 4 complimentary label orders per fiscal year (July 1 – June 30). Please fill out the information below. AACN requires that you submit the mail piece (brochure, flyer, postcard, etc.) for label orders for chapter/regional educational events. The mail piece can be submitted by fax to the List Rental Department at (949) 448-5572 or by email to

Request Details: All orders should be submitted at least 10 business days prior to the date the materials are needed, plus an additional 5-7 business days for shipping.
List rentals include the following information:

  • Member Name
  • Address
  • City, State, Zip Code

Due to AACN's Privacy Policy, and out of respect to our members, other member information cannot be provided, such as email address, telephone numbers, certifications, etc.

Please keep in mind that when you are requesting labels, your list will intersect with other chapter members in the area. It is important that chapters use these lists, appropriately, to invite other chapter members to events and to collaborate, not as a competition base to recruit new members from other chapters.

A maximum of a 100 mile radius can be selected for each list rental request. If you require a larger area, or need guidance, please contact the List Rental Department at 800-394-5995, x209.

Requestor Information

Requestor Name: *
Requestor Email: *
Requestor Phone : *
Position in Chapter: *
Chapter Name : *
please spell out the full chapter name
Chapter Zip Code: *
How will this request be used?:

If other, please specify:

Order Requirements

Requested Delivery Date: *
mm/dd/yyyy (See processing time frame listed above)
Output Format: *
Data file output will be in Microsoft Excel format.
Radius of Zip Code: *
If other, please describe in the Comments section, below.

Shipping Requirements

Delivery Method: *
If "Email" is requested, list address below. If "Ship" is requested, list address in the "Mailing Information" section, below.
Email Address:
Shipping Method:

(*If you require express mail shipping, the chapter will be responsible for the shipping charges and will be billed accordingly. Packages shipped to PO Boxes must be sent through the United States Postal Services. Fed Ex requests cannot be accommodated for PO Boxes.)

Mailing Information

Zip Code:
Home Phone:
Work Phone:
Fax Phone :






revised 2/13

Your Feedback