IFFM Membership Form

Be part of the solution with an annual IFFM membership!

YES, Count me in!
I want to be part of Illinois Families For Midwifery, promoting gentle birth with midwives.

Name_______________________________________
Street _______________________________________
City___________________ State _____ Zip ________
Home Phone (____) ___________________________
E-mail ______________________________________
Where did you hear of IFFM? ____________________

Which of the following applies to you? (check all that apply):
[ ] concerned citizen       [ ] home birth parent
[ ] childbirth educator     [ ] doula
[ ] midwife (type: ________________________________)
[ ] midwifery student       [ ] other _____________________

IFFM has a strict privacy policy. We will not share your information with any unrelated groups. However, there are times when special occasions arise. If you would like to receive very occasional mailings, from carefully screened, directly related groups, check here [ ]

There's more than one Level of Support
(Please check one)

Basic Annual Membership $15 [ ]
By joining IFFM for only $15, Members receive quarterly newsletters and the satisfaction of knowing they are supporting efforts to keep midwifery available in Illinois!

SUGGESTED Membership $25 [ ]
With a contribution of $25, Patrons receive the newsletter and a free advocacy notebook, plus help to defray the costs of materials passed out at public events and to professional organizations.

Benefactor $40 [ ]
With a $40 contribution, in addition to all the above benefits, Benefactors support our development of display materials and brochures.

Angel $75 [ ]
Angels who contribute $75 or more receive all the benefits plus a certificate of appreciation and acknowledgment in our newsletter. Angels also support direct lobbying efforts.

While IFFM is not-for-profit and volunteer run, because we do a large amount of lobbying, our memberships are NOT tax deductable. But your membership fees still go to a very worthy cause!