Membership Form

If you are not a current member of ATM (student or licensed midwife) please fill out this form. If you need to renew your membership log into your portal and you will find an invoice for your renewal. Thank you for supporting midwifery in Texas!!

Member Information

First Name^*

Last Name^*

Email^*

Phone Number^*

Address^*

City^*

State^*

Zip Code^*

Student Details

Are you registering as a student midwife?

If you are a student, what program are you enrolled in?

What Region are you located in?

ATM Regions by County

Map of ATM regions: Region 1 - Central Texas, Region 2 - Panhandle, Region 3 - El Paso/Midland/Odessa, Region 4 - Houston, Region 5 - North Texas, Region 6 - San Antonio, Region 7 - East Texas, Region 8 - South Texas

What region are you located in?^*

Fees

Other Fees
Please select 1 to 3 fees payment below:
	Student Membership - Association of Texas Midwives (ATM)	30
	Associate Membership for the Association of Texas Midwives	75
	Lifetime Member for the Association of Texas Midwives	1000
	Total	0.00

Membership Form

Member Information

Student Details

What Region are you located in?

ATM Regions by County

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