Renew KMA Membership Form
Welcome KMA members! Thank you Midwives, Students, Birth Workers, and supporters for renewing your membership with the Kansas Midwives Alliance. Please ensure we have your accurate information below, and after you submit this form you'll be provided with PayPal information to pay your annual dues.
Email address *
First Name *
Your answer
Last Name
Your answer
I have read and agree to the KMA Bylaws and support the KMA and its objectives. *
How are you involved with birthing families? Midwives, if you want to be listed on the KMA website, this is the short bio about you and your services that will be used for the website. Please clearly describe your practice area or location, and if you travel for births. Include what region(s) or miles you travel. (We get many inquiries for this!) *
Your answer
Credentials to be listed with your name along with license/certification number and date of expiry. (examples: CNM, CPM, Midwife or IBCLC, etc - anything you need included with your name in when being addressed professionally).
Your answer
Are you renewing as a voting or nonvoting member? *
Are you a practicing midwife per KMA bylaw descriptions? "A CPM, CNM, CM or other midwife who meets or exceeds NARM CPM application and recertification requirements and currently attends women in childbirth by providing evidence-based prenatal, intrapartum, and postpartum care, and may provide well-woman care." *
Students, please provide the name and contact info for your preceptor, and/or program enrolled in:
Your answer
Business Name
Your answer
Mailing address *
Your answer
Address (alternate)
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone *
Your answer
Phone (alternate)
Your answer
Email *
Your answer
Website
Your answer
*Midwives: If you have opted to be on the website email a head and shoulders photo similar to those on the site to: advocate.ks.midwives@gmail.com
A copy of your responses will be emailed to the address you provided.
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