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NY CPM, Inc. General Membership Application
Thank you for your interest in our organization! This form is for current and future CPMs who would like to join. If you not currently a CPM or interested in becoming one, you are welcome to fill out our Friends of NY CPM form to be updated on our current calls to action, current events and other news! Here is the link for that:
https://docs.google.com/forms/d/e/1FAIpQLSdQT53YYf7V2xr-ii7M2ynLhj3pjjGE8ec8jInpVDoc24wD2w/viewform?usp=sf_link
This form is managed in collaboration with organizer Katy Cecen with the Movement to Birth Liberation.
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Email
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Name
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Pronoun
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Street Address
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City
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State
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Zip
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Phone
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Twitter handle
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Instagram handle
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Credential/License (If CPM MEAC, PEP, PEP + Bridge)
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Do you have time or skills you would like to donate to NY CPM Inc by Joining a committee?
Political action committee
Social media committee
Legislative committee
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Are you currently experiencing barriers to CPM care or education?
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NY CPM, Inc. is a non profit. Our work is great and our fight long. If you feel or are in a position to make a donation a suggested dollar amount would be $25-$150. No applicant for general membership will be excluded due to inability to pay. Upon submitting this form a PayPal link will be display.
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