ALATA Only Membership Application

Do not complete this application if you are a member of the NATA in good standing. NATA members are automatically granted ALATA membership.

If you are applying for retired membership, contact Chris Clark at secretary@alathletictrainers.org.

Membership is granted pending verification of State of Alabama Licensure, fees, and approval of the Executive Council.

First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Date

Phone

BOC Number

NPI Number

AL License Number

Other Healthcare Credential(s)

Membership Category

Certified/Licensed - $45

Associate - $45

Honorary Student - $10

Certified Student - $10

ALATA dues are not tax deductible as a charitable contribution, but may be deducted as a business expense.

Thank you for your application.You will receive a follow-up email with your application status soon.