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ATHNA Membership Form
Welcome to the American Travel Health Nurses Association! Please complete this form to become a member.
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First Name
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Your answer
Last Name
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Your answer
Personal Email Address (not work email)
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Your answer
Confirm Email Address
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Street Address
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Your answer
City
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Your answer
State/Province/Region
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Your answer
Zip/Mail Code
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Your answer
Country
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U.S.
Other:
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Mobile Phone Number
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Your answer
Employment Setting - check all that apply:
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Occupational Health
College Health
Academia
Public/Community Health
Hospital
Travel Clinic
Military
Government Offices (FBI, CIA, U.S. Embassies, etc.)
Group Multi-Specialty Practice
Pharmacy
Telehealth
Self-Employed
Retired
Other:
Required
Years in Travel Health Nursing
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Your answer
Highest Education:
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Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Other:
Licensure:
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LPN/LVN
RN
NP
CNS
Other:
Where did you hear about ATHNA
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