ATM Membership Application

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.

Active Midwife Membership - $60 (any Individual that is currently licensed as a midwife and practicing midwifery, or a CNM serving as midwife/primary birth attendant.)

Retired Midwife Membership - $60 (any individual that has practiced midwifery in the past.)

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".

Student - $30 (Individual training to be a midwife. Must maintain a verifiable student status)

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.

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

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

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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

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.

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!