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Idaho Midwifery Council
All rights reserved.

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Idaho Midwifery Council Membership Application

 Membership in the Idaho Midwifery Council runs from January 1 to December 31 of the current year, with renewal due on January 1 of the next year.  Benefits of membership include but are not limited to periodic newsletters, access to statewide networking and discounts on IMC sponsored conferences and workshops.

Contact Information

 

Name

 

Street Address

 

City, State, Zip Code

 

Home Phone

 

Work Phone

 

Cell Phone

 

Fax

 

E-Mail Address

 

Website address

 

idahomidwives.org listing Include my listing on “Find a Midwife” page:    ___ Yes      ___ No
IMC Newsletter preference ____ Email (preferred)               ____ Printed          

 

Who are you in Midwifery?          (Please check all which apply.)

 

 

___ LM, CPM

___ DEM

___ Doula/CBE

 

___ CNM

___ Student

___ Other

 

 

Membership type and payment:  Current membership is January 1 – December 31.

 

 

___ Voting member, open to midwives and student midwives

$35 per year

 

___ Non-voting member

$15 per year

 

Payment should be made out to Idaho Midwifery Council and may be submitted by:

 

___ Check

___ Money Order

___ Paypal, by online payment

 

 

Submit application

 

 

Submit your completed application with payment:

___ by mail to Kendra Scarlett, 388 Coyote Way, Bonners Ferry, ID  83805

___ by email to Kendra Scarlett at zfreen@nidaho.net.

 

 

 

 

 


Online payment option: