Support IMA

Midwife Member

I am a midwife and wish to join IMA. Enclosed please find one year ($30) membership dues, which includes a one year subscription to the quarterly newsletter: The Midwives Connection.

Supporting Member

I wish to join IMA as a supporting member. Enclosed please find one year ($30) membership dues, which includes a one year subscription to the quarterly newsletter: The Midwives Connection.

Newsletter Only

I do not wish to become an IMA member. Enclosed is $15 fee for one year subscription to the quarterly newsletter: The Midwives Connection.

Donation

I would like to make a donation to further the work of IMA.

Name

Title

Address

City

State

Zip

Phone

Email

Web Site

Please Check All That Apply:

Midwife

Nurse

Other Health Professional

Other

Midwife Apprentice

Childbirth Educator

Parent

Please Return this form along with your payment to:

Indiana Midwives Association

Post Office Box 3704

West Lafayette, IN 47996