Healthcare Census | National Air Transportation Association

NATA Healthcare Initiative Program Census

"*" indicates required fields

Name*

First Last

Email*

Phone*

Company*

Date of Birth*

Sex*

Female

Male

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gross Salary (current estimated)*

Payroll Frequency (paychecks per year)*

Deduction Frequency (can be same or different than paychecks)*

Title*

Hours per Week*

Hire Date*

Status (active)*

Medical Coverage*

Medical Option*

Dental Coverage*

Dental Option*

Thank you for your information. Please hit submit below to complete the form.

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