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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: