BCN Membership 2018
Thank you for your interest in becoming a Birth Care Network Member! Please complete the form below. Once submitted, please follow the instructions to complete your payment. Your membership listing will be updated on the site once both the form AND payment have been submitted. Membership renewal is required in March of each year and will begin taking place on March 1, 2019.

Membership WILL INCLUDE the following for each listing:
Name + Credentials if applicable
Phone (unless specified to be masked below)
Email (unless specified to be masked below)

A member survey has also been included at the base of the form. Please feel free to list any additional services or specialized training you may offer/have. However, there is no obligation to complete this portion of the form. This information will NOT be listed on the BCN site with your member listing.

We look forward to seeing you at the next meeting!

Name *
Your answer
Credentials *
CD(DONA), LCCE, etc. This will follow your name in your listing.
Your answer
Website or Social Media Address *
Your listing will be hyperlinked to this destination. Feel free to provide whichever social media platform you primarily use to engage with potential clients.
Your answer
Would you like your site included in your listing?
Phone Number (xxx-xxx-xxxx) *
Your answer
Would you like your number displayed in your listing?
Email Address *
Your answer
Would you like your email included in your listing?
In which of the following categories are you trained and/or have credentials? *
You may check all that apply.
Required
Certifying Organization *
Please list each category and the organization(s) through which you hold a current certification in good standing. For example. Birth Doula - DONA International. You may potentially be requested to provide a copy of the certificate.
Your answer
Website Listing *
We have three main categories for listing members. Please check all you would like to be listed under. For the "Other Local Business Category," please leave the specific area you would like to be included under and we will do our best to accommodate your request.
Required
Membership Type *
Midwifery or Doula groups may choose to be listed individually, as a group or both. Please complete separate applications for the group and individual members.
Comments
Need to be listed in a specific area that isn't clear? (ie. massage therapist, photographer, yoga teacher, etc.) Have questions regarding membership?
Your answer
I understand that my membership application is not complete until I submit payment via PayPal.* *
MEMBER SURVEY
Please feel free to check any additional services or specialized training you may offer/have. However, there is no obligation to complete this portion of the form. This information will NOT be listed on the BCN site with your member listing.
Special Services You Provide
Specialized Training or Previous Experience Relevant to your listing
Submit
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