Your name 
Internet address  
                 ---------------------------------------------
    Job Category  College - internship/residency/part-timeCollege - staff/faculty full-timeClinicClinic - outreachGraduate AssistantshipHigh SchoolIndustrial and CorporateInternationalProfessional Sports
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   Employer name 
                 (person who's making hiring decision)
  Employer title 
   Employment at 
                 (name of institute/school/company/organization)

 Mailing Address 
                 
                 
            City  ST  ALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAVIWAWVWIWYABBCMBNFNSNBNTONPEPQYNSA ZIP 
         Country    Phone number () -
                                  Fax number () -
       ------------ NATA District Information ------------------
        District    1  (CT, ME, MA, NH, RI, VT, PQ, NB, NS)
        District    2  (DE, NJ, NY, PA)
        District    3  (MD, NC, SC, VA, WV, DC)
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        District    8  (CA, HI, NV)
        District    9  (AL, FL, GA, KY, LA, MS, TN)
        District   10  (AK, ID, MT, OR, WA, AB, BC, SA)
        International  (Other than USA and Canada)
       ---------------------------------------------------------
  Position Title 
 The position is Full-timePart-timeAssistantshipIntern position
          Salary 
     Application procedure (please describe)
       
  Qualifications (please describe)
       
    Closing Date  (YEAR-MM-DD, ex: 1997-08-31)

    (PLEASE double-check your return e-mail address, fax/phone number.) 

    Confirmation  "I'll review it when the list is published."
                  "I'd like the NATA office to contact me via
                      e-mail to confirm the receipt of information."
                  "I'd like the NATA office to contact me via
                      fax to confirm the receipt of information."
                  "I'd like the NATA office to contact me via
                      phone to confirm the receipt of information."
____________________________________________________________________________________
NATA Placement Bulletin during the NATA Clinical Symposium:
                 We will advertise during the NATA Clinical Symposium
                 Interviews will be conducted during
                    the NATA Clinical Symposium
                 We'd like to know more about the process during
                    the NATA Clinical Symposium