Become a Member Please completely fill out the following membership application to become a member. You will be directed to pay your dues after you click the submit button. If you have questions, please contact us via email midwivesallianceofpa @ gmail.com Membership Form Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Personal PhoneBusiness PhonePractice NameWebsite License or Credential Information (if applicable)* DEM (Direct Entry Midwife)/Traditional Midwife CPM (Certified Professional Midwife) CNM (Certified Nurse Midwife) CM (Certified Midwife) Licensed Midwife (New Jersey) Licensed Midwive (Virginia) Licensed Midwife (Other state) RN (Registered Nurse) Doula Childbirth Educator Lactation Consultant Placenta Encapsulator Prenatal Yoga Instructor Other Not a Birthworker Please check as many as apply.Membership InformationPlease Choose Your Membership Category*Voting: Midwife/Assistant (CPM/DEM/CNM/CM/Traditional), Dues: $50Voting: Student/Apprentice/Aspiring Midwife, Dues: $35Non-Voting: Supporting Member (Doula, Childbirth educator, Lactation Consultant, etc), Dues: $30Non-Voting: Consumer Representative, Dues: $30Special Circumstances: Financial Hardship, Dues: $1An invoice for your membership dues will be generated from the information you provide in this section.If you are a midwife, please provide some information on the area that you serve. If you have a link to a map of your service area, you can include that here.This can include a specific region, key cities, towns and/or countries.If you are a consumer or other practitioner, please describe the services you offer or any special skills you have.Region: Where do you reside or practice?* Region 1: Northeastern Pa Region 2: Southeastern Pa Region 3: Northcentral Pa Region 4: Southcentral Pa Region 5: Northwestern Pa Region 6: Southwestern Pa This is used to determine which Region you are organized with. We are not strict about Regions. Please choose the area that you feel most comfortable with.Please indicate activities that you may wish to participate in Membership Drives Fundraising Events Community Outreach and Educational Events Electoral/Campaign Work Administration/Organizational Development Practice Guidelines Regional Peer Reviews You may choose more than oneAdministrative Information and PreferencesWhat is your preferred method of voting?* I prefer to cast my vote electronically. I prefer to cast my vote by paper ballot. There are times when a membership wide vote must be taken (votes on Govering Council officers, approval of Practice Guidelines, and support of legislation). Please choose which method of voting you'd prefer to utilize. This can be changed in the future by contacting a member of the Governing Council.What is your preferred method of contact?* Email Phone Paper (USPS) mail We'd like to keep all members up to date with events, legislative updates, and other items of interest.Are you interested in serving as a Regional Represenative?*YesNoRegional Represenatives are volunteer leaders that take responsibility for organizing the members in their geographic Region.If you are a MIDWIFE, STUDENT MIDWIFE, or ASSISTANT MIDWIFE, would you like an invitation to join the MAP Facebook group that is only for Midwives, Student Midwives, & Assistants?This is a member-only, closed Facebook group. If you qualify and are interested in joining, please provide the email address that you sign onto Facebook with so an invitation can be generated for you.Check the following items before you submit your application for membership.* Membership Dues renew every January. Membership Dues are due after submitting an application. Membership Dues are not prorated.