NYSALM

The 2008 Annual Meeting and Lobby Day is just around the corner...
This year it is on a MONDAY - April 14th. Register online.

Lobby Day information for participants

Join or Renew your 2008 membership today.

2008 NYSALM Membership - Online Form
Personal Information
Name		Title (Select One): CM CNM SM SNM
Address:
City:		State:	Zip:
Phone:		Email:
Practice Information
Name:
Address:
City:		State:	Zip:
Phone:		Fax:
Email:		Website:
Check if you DO NOT want your practice information listed in the NYSALM Directory
NYSALM District:
Employed by (check all that apply):
	Self	Government	Midwife (Other than Self)
	Physician	Educational Institution	Hospital
	Clinic	Faculty Practice	Military
	Other:
Type of Practice:
	Prenatal	Education	Intrapartum
	Endometrial Biopsy	Circumcision	Family Planning
	Well Woman GYN	Infertility Care	Colposcopy
	Primary Care
Site of Deliveries (Check all that apply):
	Hospital	Birth Center	Home
Number of Births You Attend Per Year:
Total Number of Births Per Practice Per Year:
Does your practice precept students? Yes No
If yes, what level students? (check all that apply)
	Midwifery - Beginner Student	Midwifery - Integration Student	Nurse Practitioner
	Physician Assistant	Medical Student	Family Practice Resident
	OB Resident	Other:
Educational Degrees (Check all that apply):
	Diploma	Associate	Bachelor's
	Certification Program	Master's	PhD / Doctorate
Malpractice Insurer:
	MLMIC	FTCA	Through ACNM
	Other:
Clients Served (enter percent):
	% Medicaid / Medicaid HMO / PCAP
	% Non-English Speaking
Membership Categories:
	Active (NY Licensed Midwives)	Associate	Corporate
	Voting Members	Non-Voting Members	Non-Voting Members
	Yearly - $150 Lifetime - $2250	Student Midwife - $37.50 Associate - $112.50	Corporate - $500
Donation for legislative effort (optional):
Donation for organization needs (optional):
Contributions or gifts to NYSALM are not tax-deductible as charitable contributions; however some portion of membership dues may be tax-deductible as ordinary and necessary business expenses
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