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 (2008) or sign up today for a Lifetime Membership and help ensure CIMS’ long-term goal of Making Mother-Friendly Care A Reality.

Join the CIMS Membership today by returning your payment along with a completed Individual Membership Form [PDF] or complete the form below to join online with a credit card.

I choose the following membership category:*

Membership* Category	Membership Fee	Member Benefits
2008 Friend	$ 25	Join today to receive recognition on the CIMS web site, CIMS product discounts, the e-CIMS newsletter and your FREE copy of The Evidence Basis for the Ten Steps of Mother-Friendly Care, The Journal of Perinatal Education, Winter 2007 Supplement.
2008 Partner	$ 50	2008 “Partner” Members also receive a CIMS canvas tote – the perfect way to show your support for Mother-Friendly Care on the road and at home!
2008 Angel	$ 100	2008 “Angel” Members automatically receive a complimentary copy of The Evidence Basis document, the CIMS toteand special recognition at all 2008 CIMS events.
Lifetime Friend	$ 500	In addition to the annual member benefits above, all Lifetime Members enjoy discounted Lifetime Member rates for the CIMS Annual Mother-Friendly Childbirth Forum, special recognition at all CIMS events and more!
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:*

Website:

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:*
If payment by a check, please download the pdf form and mail it in with your check.
a credit card

Card Type:*
Visa
Mastercard

Card #:*

Exp. Date:*

Name on Card:*

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

Mother-Friendly Childbirth Initiative Evidence Basis for the MFCI Become a Member Support CIMS Endorse the MFCI

© 2008 Coalition for Improving Maternity Services. All Rights Reserved. Created by Media Genesis and PM Consulting
Some of the photos on this site are courtesy of Lesley Mason.
CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.