How to become a member

Print and fill out this form. Mail it to:
North Carolina Friends of Midwifery
Rt. 2 Box 327
Walstonburg, NC 27888

( ) Please include me on your mailing list
*Enclosed is __$5.00 __$10.00 __$20.00 
________(Fill in amount)

Name______________________________________ Phone___________________

Street_____________________________________________

City____________________ State_______ Zip_________________

Parent_____ Childbirth Educator_____ Midwife_____

Health Care Professional_____ Other____________________________

Comments and Volunteer talents_____________________________________________

___________________________________________________________________________

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*Donations are appreciated but not required to recieve 
NCFOM's newsletter.  All donations go 100% to operations.