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WVATA Membership
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Email
*
Your email
Date
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MM
/
DD
/
YYYY
First and Last Name
*
Your answer
Credentials (Degrees, Licenses, Certifications)
Your answer
Board of Certification # (if Applicable)
Your answer
Athletic Trainer License # (if Applicable)
Your answer
Job Setting (Select All That Apply)
*
Clinic-Hospital, Physical Therapy, or Chiropractic
College/University-Faculty/Academic/Research
College/University - Athletics
College/University - Administration
Performing Arts
Industrial/Occupational/Corporate
Military
Professional Sports
Secondary School
Public Safety
Student
Other:
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Address
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Your answer
City
*
Your answer
State
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Your answer
Zip Code
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Your answer
Membership Categories
*
Certified Athletic Trainer-$30
Special Members (Physicians, Physical Therapists, Physician Assistants, Nurses, Other Healthcare professionals)-$30
Student Member (Graduate/Undergraduate/High School)-$10
Honorary Member-$0
Retired Member-$0
Other:
Donations: To help enhance the practice advancement and profession of athletic training in the state of West Virginia.
$100
$75
$50
$25
None
Other:
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