Join
the Colorado Alliance of Independent Midwives
First
Name __________________________
Last Name __________________________
Address
____________________________
City _______________________________
State
______________________________
Zip Code ___________________________
Home
Phone ________________________
Work Phone ________________________
E-Mail ____________________________
Please
circle one:
I
would prefer to receive the newsletter by: E-mail / Snail Mail.
Yes / No - I am interested in a payment plan or a reduced fee membership,
explanation is enclosed.
Yes / No - I am interested in volunteering for committee work (
please list areas of interest):__________________________________________________________
Yes /No - My name and address may be released for persons seeking
a midwife persons doing research.
*OPTIONAL- I am a:
Please
make checks payable to:
C-AIM
P.O. Box 40576
Denver, CO 80204-9998
Annual
Membership Fee: $50.00
NOTE:
You must print this form or cut and paste it into an email, fill
it out, and mail it to the address above. To print simply
press the Print button on your browser.
For
more information, contact us via email at homebirthcolorado@yahoo.com

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