ATM Membership Application

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To join ATM, use the following form. Fill it out and submit. You will then be directed to a page with the option of paying online using Pay Pal. If you prefer to pay by check or money order, you will need to print this page before you click the submit button and mail it along with your payment to:

Association of Texas Midwives
P. O. Box 887
Elmendorf, TX. 78112
Phone : 432-664-8815

Before applying for membership please read the following documents carefully.
Note: You must be at least 18 years of age to become an ATM member.

[ The Association of Texas Midwives
Standards of Midwifery Practice ]

[ The Association of Texas Midwives
Code for Ethical Midwifery Practice ]

Your full name

Home Phone (with area code)

Work Phone

Fax #

Other phone (specify type)

Street or PO Box

City

State

Zip Code

E-mail

What type of midwife are you? Hold down your control key
and select more than one if applicable.

TDH Documentation #

What county do you live in?

Check here if this is also your
primary county of practice

If not, please list which county
is your primary county of practice.

Please select one of the following membership options:

Active Midwife Membership - $60

For any Individual that is currently licensed as a midwife and practicing midwifery, or a CNM serving as midwife/primary birth attendant.

I Want an ATM Webpage
NOTE: Only active members can receive a webpage.
If you would like to find out more information about getting an ATM webpage, please visit this page: "Additional ATM Webpage Information".

Retired Midwife Membership - $60

For any individual that has practiced midwifery in the past.

Student - $30

Individual training to be a midwife. Must maintain a verifiable student status.
Which course are you taking?

Supporting Membership - $30

Others wishing to support this organization and may volunteer in various areas to promote the goals and objectives of the Association of Texas Midwives.

Prorate fee

Check this box if you are renewing mid-year and qualify for the prorated renewal fee.

Total Amount Due:
(Total Amount May be prorated)

Memberships shall be renewed each January. If you are renewing in the middle of the year you may prorate your membership dues.

Click here for a list of pro-rated amounts.

close X

Prorated Membership Rates
	Active/Retired Midwife Members	Students/Supporting Members
January	$60.00	$30.00
February	$55.00	$27.50
March	$50.00	$25.00
April	$45.00	$22.50
May	$40.00	$20.00
June	$35.00	$17.50
July	$30.00	$15.00
August	$25.00	$12.50
Septemeber	$20.00	$10.00
October	$15.00	$7.50
November	$10.00	$5.00
December	$5.00	$2.50

ATM Website Member Areas

Some sections of the ATM website are reserved for members only. All members may have full access to any part of the ATM Website, but a password is needed for full access. For example: Some articles may not be read in their entirety without a password. You may also test for CEUs with a password. We encourage you to select a password now. But you can apply for one later if you do not do so now. Once your password has been activated, you will be contacted by email to confirm.

You may use up to 10 digits (numbers, letters, or a combination). The password will be case sensitive, so remember what you capitalize!
Choose your password:
Confirm your password (type it again).

Your username will be the first letter of your first name and your last name.
i.e., Jane Doe's username would be JDoe.

All members will receive mailings and information about ATM business, education, legislation and other state news.

When joining please be sure you agree with each of the following:

Association of Texas Midwives Mission Statement: To advance the quality and accessibility of midwifery in Texas.

Image Statement: ATM nurtures the profession and traditions of midwifery in Texas.

Purpose: To support and promote safe birth alternatives including natural childbirth, family centered maternity care, and home birth.

Check here if you agree with the above statements.

How do you plan to pay your fees? With PayPal Mail a check or money order.

Comments or questions? 500 of 500 characters left.

If you perfer to use your credit card through Pay Pal, please note the amount of your dues because you will need to enter that amount on the Pay Pal form. If you are not a member of Pay Pal you will be given the opportunity to join.

Pressing submit will send your information to ATM. Verify that all information contained in this form is acturate before pressing submit. Thank you for your interest!

Page Last Updated: January 1, 2013

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