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ATNI (Aquatic Therapy Network of India) Membership form
Please fill up this form for applying to become member of Aquatic Therapy Network of India.
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Email
*
Your email
Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other:
Profession
*
Choose
Physiotherapist
Occupational Therapist
Aqua Fitness Practitioner
Watsu Practitioner
Others
If others specify
Your answer
If you have had an Aquatic Therapy Education - Please provide Details
Your answer
Are you currently practicing Aquatic therapy or any form Aquatic Body work ?
*
Yes
No
Years of Experience in Aquatic Therapy
0 - 2 years
2 - 5 years
5 - 10 years
> 10 years
Please share your Objective of Joining ATNI
*
Your answer
Contact Number
*
Your answer
Share with us your Location in India, mention State, District and City
*
Your answer
All the information provided by me in the ATNI registration form are correct and true. I will be solely held responsible for it. ATNI holds no bearings on the information provided by the Registering member.
*
I Accept
I Do Not Accept
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