Tennessee Midwives Association
Membership Information Form
Name
Address
Phone
Email
Do you use email regularly/is your
email address reliable?
Membership
Category:
Voting Member ($35)
Midwife ( CPM CNM Other Midwife)
Apprentice Midwife
Midwife’s Assistant
Supporting Member ($25) ( Midwifery Student Other Supporter
Other Birth Professional: )
Please
send this membership form along with check made out to TMA to:
Kimberly Spencer, President
5013 Sunset Way
Hermitage, TN 37076
As
of January 1, 2006, consumers will no longer be able to request midwife
referrals through email. Instead, midwives will be listed on the TMA website so
that consumers interested in midwifery services may contact the midwives
directly.
Do
you want to publish your practice information on the TMA website?
If
yes, please fill out the accompanying
Website Directory Form and mail or fax to
Kimberly
Spencer at the address provided on the form.
TMA
Website Directory Form
Please provide the following information as you want
it to appear on the TMA website. We will publish any or all of the information
you wish. You do not need to provide all of your contact information in order
to be published on the website. Fill in only the information you want to
have published. Email and website addresses will appear as hyperlinks. If
you have any questions please contact Kimberly Spencer at (615) 883-8744 or
aowyn@bellsouth.net.
An
example of how a complete listing would appear:
Helping Hands Midwifery (link)
5013 Sunset Way Hermitage, TN 37076 Phone: (615) 883-8744 Fax: (615) 872-9522 Email: info@helpinghands.com (link) Midwives: Marilyn Greene, CPM & Kimberly Spencer, CPM Practice Name (You may list your name if you do not practice under a business name) Website Address Mailing Address Phone Number Alternate Phone
Fax
Number
Email
Address
Midwives
Names
By
signing I grant permission for the preceding information to be published on the
TMA website:
(signature) (date)
Mail or fax this form to: Kimberly
Spencer
5013
Sunset Way
Hermitage,
TN 37076