Idaho Midwifery Council
Membership Application
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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.
City, State, Zip code_____________________________________________________________________
Home phone___________________________________________________________________________
work phone____________________________________________________________________________
Cell phone_____________________________________________________________________________
Fax___________________________________________________________________________________
Email 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?
____LM,
Idaho
____CNM
____Student
____LM, other state
____CPM
____DEM
____Doula/CBE
Specify:
Membership type and payment (Current membership is January 1 - December 31.)
____Voting member, open to midwives and student midwives; $35.00 per year
____Non-voting member; $15.00 per year
Payment should be made our 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@me.com.
NOTE: If your purchase your membership by Paypal, be sure to send completed form to Kendra.