Get Involved: Individual Membership Form

CIMS Individual Membership Form

Help us to become a powerful voice for evidence-based maternity care by joining CIMS with a 1-Year Membership or sign up today for a Lifetime Membership and help ensure CIMS’ long-term goal of Making Mother-Friendly Care A Reality. Join today and enjoy the benefits of membership through Dec. 31, 2010.

Join the CIMS Membership today! [PDF] or fill out the online form below.

I choose the following membership category:*

Membership* Category	Membership Fee	Member Benefits
2010 Friend	$ 25	Join today to receive recognition on the CIMS web site, CIMS product discounts, and the e-CIMS newsletter.
2010 Partner	$ 50	2010 “Partner” Members receive a FREE copy of The Evidence Basis for the Ten Steps of Mother-Friendly Care, published by The Journal of Perinatal Education, Winter 2007 Supplement.
2010 Angel	$ 100	2010 “Angel” Members automatically receive a complimentary copy of The Evidence Basis document and a CIMS canvas tote – the perfect way to show your support for Mother-Friendly Care on the road and at home!
Lifetime Friend	$ 500	In addition to the annual member benefits above, all Lifetime Members enjoy discounted member registration rates for the CIMS Annual Mother-Friendly Childbirth Forum and special recognition at all CIMS events!
Lifetime Partner	$ 1,000	Lifetime “Partner” Members also receive a unique pendant gift inspired by our shared commitment to Mother-Friendly Care and designed exclusively for our most prestigious Lifetime “Partner” and Lifetime “Angel” Members.
Lifetime Angel	$ 2,500	Our cherished Lifetime “Angel” Members receive the CIMS pendant gift and a personalized Certificate of Recognition for their commitment to Making Mother-Friendly Care A Reality.

First Name:*

Last Name:*

Credentials/Degrees:

Address:*

City:*

State/Providence:*

Zip:*

Country:*

Telephone:*

Fax:

Email:*

Organization Affiliation (if any):

I am a:

Check all that apply
Consumer
Birth Advocate
Childbirth Educator
Lactation Consultant
Doula
Midwife
Nurse
Physician

Do not include my name in the member list on the CIMS web site.

Payment by:*
a check
a credit card

Total: $
A check for $will be mailed to:
Coalition for Improving Maternity Services (CIMS)
1500 Sunday Drive Suite 102
Raleigh, NC 27607
One-time credit card payment of $

or Recurring credit card payment plan (maximum of 4 payments.) Please charge my credit card as follows:
$ on(date)
$ on(date)
$ on(date)
$ on(date)

Links

Purchase Mother-Friendly Publications and Products from CIMS

Downloads

Download and print the PDF version of this form and mail or fax it to:

Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607
Telephone: 919.863.9482
Fax 904-285-2120